Healthcare Provider Details

I. General information

NPI: 1861148454
Provider Name (Legal Business Name): BOBBI SUE HULLUM APRN CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BOBBI HODGE

II. Dates (important events)

Enumeration Date: 02/23/2022
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2249 STATE ROUTE 5
CORTLAND OH
44410-9333
US

IV. Provider business mailing address

807 SOUTHWESTERN RUN
POLAND OH
44514-3688
US

V. Phone/Fax

Practice location:
  • Phone: 330-372-1608
  • Fax:
Mailing address:
  • Phone: 330-729-0059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN.CNP.0030834
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: