Healthcare Provider Details

I. General information

NPI: 1184829079
Provider Name (Legal Business Name): MARILYN NELSON HULTER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 EUREKA WAY
REDDING CA
96001-0220
US

IV. Provider business mailing address

7417 N CEDAR AVE
FRESNO CA
93720-3637
US

V. Phone/Fax

Practice location:
  • Phone: 530-225-8700
  • Fax:
Mailing address:
  • Phone: 559-436-0871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberG28137
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: