=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376384297
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOEL HUKILL
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/04/2024
-----------------------------------------------------
Last Update Date | 06/04/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 18697 BAGLEY RD
-----------------------------------------------------
City | MIDDLEBURG HEIGHTS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44130-3417
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-816-8000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 30575 BAINBRIDGE RD STE 200
-----------------------------------------------------
City | SOLON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44139-2275
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-542-5000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2100X
-----------------------------------------------------
Taxonomy Name | Acute Care Nurse Practitioner
-----------------------------------------------------
License Number | APRN.CNP.0036596
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------