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General NPI Number Information
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NPI Number | 1265408926
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Entity Type | Individual
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Provider Name | SUSAN R HULL DO
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Gender | Female
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Dates
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Enumeration Date | 02/23/2006
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Last Update Date | 05/19/2011
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Provider Practice Location Address
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Address Line | 16555 MANCHESTER RD SUITE 100
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City | GROVER
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State | MO
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Zip | 63040-1220
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Country | US
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Telephone | 636-458-0646
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Fax |
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Provider Business Mailing Address
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Address Line | 16555 MANCHESTER RD SUITE 100
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City | GROVER
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State | MO
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Zip | 63040-1220
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Country | US
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Telephone | 636-458-0646
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | R6P24
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License Number State | MO
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