MEDICARE: ELLIE S HULL

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	363LF0000X	Family Nurse Practitioner	2022032724	MO

General Provider Information

NPI Number	:	1518684711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLIE S HULL

Provider Business Mailing Address
First Line	:	1723 BROADWAY ST STE 315
Second Line	:
City	:	CAPE GIRARDEAU
State	:	MO
Zip	:	63701-4556
Country	:	US
Telephone Number	:	573-519-4960
Fax Number	:	573-519-4655

Provider Business Practice Location Address
First Line	:	650 S MOUNT AUBURN RD STE 101
Second Line	:
City	:	CAPE GIRARDEAU
State	:	MO
Zip	:	63703-4940
Country	:	US
Telephone Number	:	573-519-4960
Fax Number	:	573-519-4655

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

Provider Enumeration Date	:	10/27/2022
Last Update Date	:	03/10/2025

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Directions to “ ELLIE S HULL ” Practice Location

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