Healthcare Provider Details

I. General information

NPI: 1922876416
Provider Name (Legal Business Name): MRS. LUCRETIA HULL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2023
Last Update Date: 12/14/2023
Certification Date: 11/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2705 W HORIZON RIDGE PKWY
HENDERSON NV
89052-4434
US

IV. Provider business mailing address

2705 W HORIZON RIDGE PKWY
HENDERSON NV
89052-4434
US

V. Phone/Fax

Practice location:
  • Phone: 702-880-4193
  • Fax:
Mailing address:
  • Phone: 702-880-4193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number873466
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: