MEDICARE: STEPHANIE KATHLEEN HULSE C.R.N.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	23771	TN
2	367500000X	Certified Registered Nurse Anesthetist	1010026456	VT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235179011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE KATHLEEN HULSE C.R.N.A.

Provider Business Mailing Address
First Line	:	111 COLCHESTER AVE
Second Line	:	FAHC-WP2
City	:	BURLINGTON
State	:	VT
Zip	:	05401-1473
Country	:	US
Telephone Number	:	802-847-2415
Fax Number	:	802-847-5324

Provider Business Practice Location Address
First Line	:	7565 DANNAHER DR
Second Line	:
City	:	POWELL
State	:	TN
Zip	:	37849-4029
Country	:	US
Telephone Number	:	865-859-8000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	05/07/2018

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