Healthcare Provider Details

I. General information

NPI: 1497419857
Provider Name (Legal Business Name): CRYSTAL HULL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2021
Last Update Date: 10/22/2021
Certification Date: 10/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 SAM PERRY BLVD
FREDERICKSBURG VA
22401-4453
US

IV. Provider business mailing address

4697 FISHERMANS CV
DUMFRIES VA
22025-1021
US

V. Phone/Fax

Practice location:
  • Phone: 540-741-1100
  • Fax:
Mailing address:
  • Phone: 703-850-7972
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024182961
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: