Healthcare Provider Details

I. General information

NPI: 1346308780
Provider Name (Legal Business Name): TAMMY L TRUDELL HULL LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAMMY L TRUDELL LMSW

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 THORNTON ST
MIDDLEVILLE MI
49333
US

IV. Provider business mailing address

PO BOX 339 402 THORNTON ST
MIDDLEVILLE MI
49333
US

V. Phone/Fax

Practice location:
  • Phone: 269-795-2243
  • Fax: 269-795-5315
Mailing address:
  • Phone: 269-795-2243
  • Fax: 269-795-5315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberL797306
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: