Healthcare Provider Details

I. General information

NPI: 1023529468
Provider Name (Legal Business Name): MOLLY MARIE HULSEN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MOLLY MARIE SWANSTON

II. Dates (important events)

Enumeration Date: 10/12/2017
Last Update Date: 04/18/2024
Certification Date: 04/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10012 KENNERLY RD STE 300
SAINT LOUIS MO
63128-2197
US

IV. Provider business mailing address

10012 KENNERLY RD STE 300
SAINT LOUIS MO
63128-2197
US

V. Phone/Fax

Practice location:
  • Phone: 314-842-0602
  • Fax:
Mailing address:
  • Phone: 314-842-0602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number2017014481
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: