Healthcare Provider Details

I. General information

NPI: 1437620424
Provider Name (Legal Business Name): CASSANDRA MARIE HULL RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2018
Last Update Date: 12/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11100 NE COXLEY DR
VANCOUVER WA
98662-6193
US

IV. Provider business mailing address

30604 NE 172ND AVE
YACOLT WA
98675-3094
US

V. Phone/Fax

Practice location:
  • Phone: 360-254-9700
  • Fax:
Mailing address:
  • Phone: 360-931-9578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH00007401
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: