Healthcare Provider Details

I. General information

NPI: 1588078281
Provider Name (Legal Business Name): MAEANN HULVEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2014
Last Update Date: 06/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 GONZALES ROAD, SUITE 102
VENTURA CA
93036-3707
US

IV. Provider business mailing address

37119 VILLAGE 37
CAMARILLO CA
93012-5608
US

V. Phone/Fax

Practice location:
  • Phone: 937-369-4304
  • Fax:
Mailing address:
  • Phone: 937-369-4304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN322244
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberRN3222244
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: