Healthcare Provider Details

I. General information

NPI: 1295278802
Provider Name (Legal Business Name): JOSEPH HULSE JR. NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2016
Last Update Date: 11/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 W JEFFERSON BLVD STE 600
SOUTH BEND IN
46601-1923
US

IV. Provider business mailing address

112 W JEFFERSON BLVD STE 600
SOUTH BEND IN
46601-1923
US

V. Phone/Fax

Practice location:
  • Phone: 574-546-1900
  • Fax: 574-546-1999
Mailing address:
  • Phone: 574-546-1900
  • Fax: 574-546-1999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71006701A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: