Healthcare Provider Details

I. General information

NPI: 1760680524
Provider Name (Legal Business Name): ELLEN B. HULL CRC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 07/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 AUBURN WAY S
AUBURN WA
98002-6132
US

IV. Provider business mailing address

1000 AUBURN WAY S
AUBURN WA
98002-6132
US

V. Phone/Fax

Practice location:
  • Phone: 425-228-3440
  • Fax: 253-395-1944
Mailing address:
  • Phone: 425-228-3440
  • Fax: 253-395-1944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number0161291
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: