Healthcare Provider Details

I. General information

NPI: 1538665369
Provider Name (Legal Business Name): AUDREY HULBERT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2018
Last Update Date: 04/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CORNELL HEALTH 110 HO PLAZA
ITHACA NY
14853
US

IV. Provider business mailing address

CORNELL HEALTH 110 HO PLAZA
ITHACA NY
14853
US

V. Phone/Fax

Practice location:
  • Phone: 607-255-5155
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number591245-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: