Healthcare Provider Details

I. General information

NPI: 1750581617
Provider Name (Legal Business Name): TINA I HULSE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2007
Last Update Date: 02/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 DEERWOOD AVE NW TRI-COUNTY HEALTH CARE WADENA CLINIC
WADENA MN
56482-1296
US

IV. Provider business mailing address

415 JEFFERSON ST NORTH TRI-COUNTY HOSPITAL
WADENA MN
56482-1296
US

V. Phone/Fax

Practice location:
  • Phone: 218-631-1360
  • Fax: 218-631-7507
Mailing address:
  • Phone: 218-631-3510
  • Fax: 218-631-7503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10267
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: