Healthcare Provider Details

I. General information

NPI: 1760105183
Provider Name (Legal Business Name): ERIN HULTGRENN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2022
Last Update Date: 09/21/2022
Certification Date: 09/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9011 BURNS RD
PASCO WA
99301-8096
US

IV. Provider business mailing address

9011 BURNS RD
PASCO WA
99301-8096
US

V. Phone/Fax

Practice location:
  • Phone: 509-546-7440
  • Fax:
Mailing address:
  • Phone: 509-546-7440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN00148302
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: