Healthcare Provider Details

I. General information

NPI: 1902836869
Provider Name (Legal Business Name): BENJAMIN L HULS CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 01/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 E 52ND ST
KEARNEY NE
68847-0502
US

IV. Provider business mailing address

PO BOX 1771
KEARNEY NE
68848-1771
US

V. Phone/Fax

Practice location:
  • Phone: 308-236-5506
  • Fax: 308-236-7089
Mailing address:
  • Phone: 308-236-5506
  • Fax: 308-236-7089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number100790
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: