Healthcare Provider Details

I. General information

NPI: 1235179011
Provider Name (Legal Business Name): STEPHANIE KATHLEEN HULSE C.R.N.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 05/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7565 DANNAHER DR
POWELL TN
37849-4029
US

IV. Provider business mailing address

111 COLCHESTER AVE FAHC-WP2
BURLINGTON VT
05401-1473
US

V. Phone/Fax

Practice location:
  • Phone: 865-859-8000
  • Fax:
Mailing address:
  • Phone: 802-847-2415
  • Fax: 802-847-5324

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number23771
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1010026456
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: