Healthcare Provider Details

I. General information

NPI: 1649590159
Provider Name (Legal Business Name): NIKKI HULL MSW, LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2010
Last Update Date: 03/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 MIRANDA AVE PALO ALTO VA HOSPITAL- SOCIAL WORK SERVICE PAD 640/122
PALO ALTO CA
94304-1207
US

IV. Provider business mailing address

3801 MIRANDA AVE PALO ALTO VA HOSPITAL- SOCIAL WORK SERVICE PAD 640/122
PALO ALTO CA
94304-1207
US

V. Phone/Fax

Practice location:
  • Phone: 650-493-5000
  • Fax:
Mailing address:
  • Phone: 650-493-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number8301
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8301
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: