Healthcare Provider Details

I. General information

NPI: 1720773690
Provider Name (Legal Business Name): STEPHANIE HULSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2023
Last Update Date: 04/06/2023
Certification Date: 04/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4371 CROWELL RD
TURLOCK CA
95382-8643
US

IV. Provider business mailing address

4371 CROWELL RD
TURLOCK CA
95382-8643
US

V. Phone/Fax

Practice location:
  • Phone: 402-516-2226
  • Fax:
Mailing address:
  • Phone: 402-516-2226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number7256-36
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number7256-23
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: