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General NPI Number Information
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NPI Number | 1457339095
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Entity Type | Individual
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Provider Name | SHANNON E HULL PAC
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Gender | Male
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Dates
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Enumeration Date | 01/04/2006
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Last Update Date | 05/30/2013
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Provider Practice Location Address
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Address Line | 502 LOCUST ST
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City | ALLISON
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State | IA
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Zip | 50602
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Country | US
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Telephone | 319-267-2759
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Fax | 319-267-2851
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Provider Business Mailing Address
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Address Line | 1001 MASON WAY
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City | SHELL ROCK
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State | IA
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Zip | 50670-1007
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Country | US
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Telephone | 319-885-6530
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Fax | 319-885-6535
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 001238
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License Number State | IA
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