Healthcare Provider Details

I. General information

NPI: 1770839441
Provider Name (Legal Business Name): TRACEY A HULL MS, RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2012
Last Update Date: 05/25/2023
Certification Date: 05/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

387 MERIDEN RD
LEBANON NH
03766-2311
US

IV. Provider business mailing address

387 MERIDEN RD
LEBANON NH
03766-2311
US

V. Phone/Fax

Practice location:
  • Phone: 603-277-0211
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number0641
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: