Healthcare Provider Details

I. General information

NPI: 1518684711
Provider Name (Legal Business Name): ELLIE S HULL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELLIE S WEILBRENNER

II. Dates (important events)

Enumeration Date: 10/27/2022
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 S MOUNT AUBURN RD STE 101
CAPE GIRARDEAU MO
63703-4940
US

IV. Provider business mailing address

1723 BROADWAY ST STE 315
CAPE GIRARDEAU MO
63701-4556
US

V. Phone/Fax

Practice location:
  • Phone: 573-519-4960
  • Fax: 573-519-4655
Mailing address:
  • Phone: 573-519-4960
  • Fax: 573-519-4655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2022032724
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: