Healthcare Provider Details

I. General information

NPI: 1255530200
Provider Name (Legal Business Name): BRITTANY NICOLE HULLUM RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2007
Last Update Date: 07/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3077 FITE CIR SUITE 6
SACRAMENTO CA
95827-1814
US

IV. Provider business mailing address

3077 FITE CIR SUITE 6
SACRAMENTO CA
95827-1814
US

V. Phone/Fax

Practice location:
  • Phone: 916-854-1801
  • Fax: 926-854-1809
Mailing address:
  • Phone: 916-854-1801
  • Fax: 926-854-1809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number697290
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number748940
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: