Healthcare Provider Details

I. General information

NPI: 1497457287
Provider Name (Legal Business Name): MATTHEW JOHN HULSMAN NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2023
Last Update Date: 04/12/2023
Certification Date: 04/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 N CHURCH ST
GREENSBORO NC
27401-1007
US

IV. Provider business mailing address

1316 LAKEWOOD DR
GREENSBORO NC
27410-4442
US

V. Phone/Fax

Practice location:
  • Phone: 336-207-7005
  • Fax:
Mailing address:
  • Phone: 336-207-1894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License Number5017748
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number5017748
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: