Healthcare Provider Details

I. General information

NPI: 1609335116
Provider Name (Legal Business Name): LAURA HULL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA HARPOLE NP

II. Dates (important events)

Enumeration Date: 03/14/2019
Last Update Date: 11/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 W WASHINGTON ST
PITTSFIELD IL
62363-1350
US

IV. Provider business mailing address

1005 BROADWAY ST
QUINCY IL
62301-2834
US

V. Phone/Fax

Practice location:
  • Phone: 217-285-2113
  • Fax:
Mailing address:
  • Phone: 217-223-8400
  • Fax: 217-277-3960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209018961
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: