Healthcare Provider Details

I. General information

NPI: 1790185189
Provider Name (Legal Business Name): JESSICA HULL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2014
Last Update Date: 09/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 N EAST AVE
JACKSON MI
49201-1753
US

IV. Provider business mailing address

205 N EAST AVE
JACKSON MI
49201-1753
US

V. Phone/Fax

Practice location:
  • Phone: 517-788-4730
  • Fax: 517-788-4701
Mailing address:
  • Phone: 517-788-4730
  • Fax: 517-788-4701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4704279787
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: