Healthcare Provider Details

I. General information

NPI: 1346320702
Provider Name (Legal Business Name): PATRICIA T HULL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PATRICIA T SMITH

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 12/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 KENYON RD UNITYPOINT AT HOME
FORT DODGE IA
50501-5740
US

IV. Provider business mailing address

802 KENYON RD UNITYPOINT AT HOME
FORT DODGE IA
50501-5740
US

V. Phone/Fax

Practice location:
  • Phone: 515-574-6416
  • Fax:
Mailing address:
  • Phone: 515-574-6416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number01447
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier07466
Identifier TypeOTHER
Identifier StateIN
Identifier IssuerWELLMARK BCBS
# 2
Identifier10852
Identifier TypeOTHER
Identifier StateIN
Identifier IssuerMIDLANDS CHOICE
# 3
Identifier0159608
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: