Healthcare Provider Details

I. General information

NPI: 1417415597
Provider Name (Legal Business Name): MRS. GRACE ELIZABETH HULSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: GRACIE ELIZABETH HULSE

II. Dates (important events)

Enumeration Date: 03/07/2019
Last Update Date: 03/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 AVALON STREET
DORAN VA
24612
US

IV. Provider business mailing address

PO BOX 599
DORAN VA
24612-0599
US

V. Phone/Fax

Practice location:
  • Phone: 276-971-9797
  • Fax: 844-303-1337
Mailing address:
  • Phone: 276-971-9797
  • Fax: 844-303-1337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: