Healthcare Provider Details

I. General information

NPI: 1548271299
Provider Name (Legal Business Name): MANDY SUE HULL BS,BHRS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 NORTH 31ST STREET
CLINTON OK
73601
US

IV. Provider business mailing address

1108 SANTA FE DR
CLINTON OK
73601-2357
US

V. Phone/Fax

Practice location:
  • Phone: 580-323-6021
  • Fax: 580-323-9375
Mailing address:
  • Phone: 580-650-9329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: