Healthcare Provider Details

I. General information

NPI: 1235772112
Provider Name (Legal Business Name): MICHELE ANN HULL APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2019
Last Update Date: 10/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 SOMMERFIELD AVE
MOUNT TABOR NJ
07878
US

IV. Provider business mailing address

PO BOX 90
MOUNT TABOR NJ
07878-0090
US

V. Phone/Fax

Practice location:
  • Phone: 201-803-6598
  • Fax:
Mailing address:
  • Phone: 201-803-6598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number402862
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: