Healthcare Provider Details

I. General information

NPI: 1659914257
Provider Name (Legal Business Name): JENNIFER HULS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2019
Last Update Date: 10/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21321 E OCOTILLO RD STE 133
QUEEN CREEK AZ
85142-5995
US

IV. Provider business mailing address

22833 E DESERT HILLS DR
QUEEN CREEK AZ
85142-8899
US

V. Phone/Fax

Practice location:
  • Phone: 480-923-7421
  • Fax:
Mailing address:
  • Phone: 309-338-9913
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number225941
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: