Healthcare Provider Details

I. General information

NPI: 1700207487
Provider Name (Legal Business Name): MARY JO HULL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2013
Last Update Date: 12/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

341 SPRUCE ST
MORGANTOWN WV
26505-5504
US

IV. Provider business mailing address

447 GRAND ST
MORGANTOWN WV
26501-6673
US

V. Phone/Fax

Practice location:
  • Phone: 304-292-8234
  • Fax:
Mailing address:
  • Phone: 304-841-2522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN82090NP
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: