MEDICARE: MS. MICHELE ANN HULL APN

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	402862	NY

General Provider Information

NPI Number	:	1235772112
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MICHELE ANN HULL APN

Provider Business Mailing Address
First Line	:	PO BOX 90
Second Line	:
City	:	MOUNT TABOR
State	:	NJ
Zip	:	07878-0090
Country	:	US
Telephone Number	:	201-803-6598
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 SOMMERFIELD AVE
Second Line	:
City	:	MOUNT TABOR
State	:	NJ
Zip	:	07878
Country	:	US
Telephone Number	:	201-803-6598
Fax Number	:

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

Provider Enumeration Date	:	10/23/2019
Last Update Date	:	10/23/2019

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