Healthcare Provider Details

I. General information

NPI: 1801059373
Provider Name (Legal Business Name): JENNIFER LYNN HULL DVM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2008
Last Update Date: 07/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1621 E MAIN ST
STOUGHTON WI
53589-1882
US

IV. Provider business mailing address

1621 E MAIN ST
STOUGHTON WI
53589-1882
US

V. Phone/Fax

Practice location:
  • Phone: 608-873-8112
  • Fax:
Mailing address:
  • Phone: 608-873-8112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number5866050
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: