Healthcare Provider Details

I. General information

NPI: 1255685657
Provider Name (Legal Business Name): BRITTANY MARIE HULICK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2012
Last Update Date: 05/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ATWELL RD
COOPERSTOWN NY
13326-1301
US

IV. Provider business mailing address

PO BOX 725
COOPERSTOWN NY
13326
US

V. Phone/Fax

Practice location:
  • Phone: 607-547-3153
  • Fax: 607-547-7805
Mailing address:
  • Phone: 607-547-3153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number599060
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: