Healthcare Provider Details

I. General information

NPI: 1457754830
Provider Name (Legal Business Name): TAMARA HULBURT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2014
Last Update Date: 09/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E GREEN ST
ITHACA NY
14850-5635
US

IV. Provider business mailing address

201 E GREEN ST
ITHACA NY
14850-5635
US

V. Phone/Fax

Practice location:
  • Phone: 607-274-6333
  • Fax: 607-274-6228
Mailing address:
  • Phone: 607-274-6333
  • Fax: 607-274-6228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: