Healthcare Provider Details

I. General information

NPI: 1679959126
Provider Name (Legal Business Name): AUDREY HULL CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2015
Last Update Date: 11/11/2022
Certification Date: 11/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8792 ST RT 335
MINFORD OH
45653
US

IV. Provider business mailing address

1735 27TH ST STE B06
PORTSMOUTH OH
45662-2681
US

V. Phone/Fax

Practice location:
  • Phone: 740-820-2141
  • Fax: 740-820-4445
Mailing address:
  • Phone: 740-356-8008
  • Fax: 740-353-7900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.17875
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: