Healthcare Provider Details

I. General information

NPI: 1053045716
Provider Name (Legal Business Name): JENNA HULL LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2022
Last Update Date: 07/10/2022
Certification Date: 07/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4512 W PLEASANT HILL RD
SALINA KS
67401-9275
US

IV. Provider business mailing address

4512 W PLEASANT HILL RD
SALINA KS
67401-9275
US

V. Phone/Fax

Practice location:
  • Phone: 785-914-7176
  • Fax:
Mailing address:
  • Phone: 785-914-7176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number23-51731-102
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: