Healthcare Provider Details

I. General information

NPI: 1811587827
Provider Name (Legal Business Name): MARY VERONICA HULME LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2021
Last Update Date: 02/23/2021
Certification Date: 02/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

189 WHEATLEY ROAD
BROOKVILLE NY
11545
US

IV. Provider business mailing address

189 WHEATLEY ROAD
BROOKVILLE NY
11545
US

V. Phone/Fax

Practice location:
  • Phone: 516-626-1075
  • Fax: 516-626-2039
Mailing address:
  • Phone: 516-626-1075
  • Fax: 516-626-2039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number301769-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: