Healthcare Provider Details

I. General information

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

II. Dates (important events)

Enumeration Date: 10/12/2017
Last Update Date: 05/12/2026
Certification Date: 04/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3015 N BALLAS RD DIV IM CARDIOLOGY, STE 225
SAINT LOUIS MO
63131-2329
US

IV. Provider business mailing address

PO BOX 7412011
CHICAGO IL
60674-2011
US

V. Phone/Fax

Practice location:
  • Phone: 314-996-3530
  • Fax: 314-996-3535
Mailing address:
  • Phone: 314-996-3530
  • Fax: 314-996-3535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number2017014481
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: