Healthcare Provider Details

I. General information

NPI: 1235591876
Provider Name (Legal Business Name): WHITLEY HULSE M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: WHITLEY JACKSON

II. Dates (important events)

Enumeration Date: 03/23/2016
Last Update Date: 06/08/2022
Certification Date: 06/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 S PARK ST
MADISON WI
53715-1507
US

IV. Provider business mailing address

7974 UW HEALTH CT
MIDDLETON WI
53562-5531
US

V. Phone/Fax

Practice location:
  • Phone: 608-417-6236
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number11265780-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number76829
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: