Healthcare Provider Details

I. General information

NPI: 1285277731
Provider Name (Legal Business Name): JENNIFER HULL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2019
Last Update Date: 12/23/2020
Certification Date: 12/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3364 KOLBE RD
LORAIN OH
44053-1628
US

IV. Provider business mailing address

6271 WINTER FOE TRL
LORAIN OH
44053-1899
US

V. Phone/Fax

Practice location:
  • Phone: 440-320-5005
  • Fax: 440-654-4055
Mailing address:
  • Phone: 440-320-5005
  • Fax: 440-654-4055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN.CNP.025545
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN.CNP.025545
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: