Healthcare Provider Details

I. General information

NPI: 1851919302
Provider Name (Legal Business Name): EMILY GRACE HULSE RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2020
Last Update Date: 07/10/2020
Certification Date: 07/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 CRESTVIEW DR
MILFORD NJ
08848-1929
US

IV. Provider business mailing address

20 CRESTVIEW DR
MILFORD NJ
08848-1929
US

V. Phone/Fax

Practice location:
  • Phone: 908-507-7146
  • Fax:
Mailing address:
  • Phone: 908-507-7146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number086118478
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: