Healthcare Provider Details

I. General information

NPI: 1538311782
Provider Name (Legal Business Name): SUSAN J HULL R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2008
Last Update Date: 10/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7B JOHNSON RD
LATHAM NY
12110-3003
US

IV. Provider business mailing address

13 PLEASANT VIEW DR
LATHAM NY
12110-1212
US

V. Phone/Fax

Practice location:
  • Phone: 518-782-7733
  • Fax: 518-782-0800
Mailing address:
  • Phone: 518-782-7733
  • Fax: 518-782-0800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number361641
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: