Healthcare Provider Details

I. General information

NPI: 1265689780
Provider Name (Legal Business Name): CHERYL BETH HULL MS, RD/LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2008
Last Update Date: 08/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3805 S 143RD EAST AVE
TULSA OK
74134-5722
US

IV. Provider business mailing address

3805 S 143RD EAST AVE
TULSA OK
74134-5722
US

V. Phone/Fax

Practice location:
  • Phone: 918-813-2800
  • Fax: 918-949-6678
Mailing address:
  • Phone: 918-813-2800
  • Fax: 918-949-6678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1528
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: