MEDICARE: KATHRYN E HULL AUD

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	231H00000X	Audiologist	23002737A	IN

General Provider Information

NPI Number	:	1720695752
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN E HULL AUD

Provider Business Mailing Address
First Line	:	10021 DUPONT CIRCLE CT
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-1604
Country	:	US
Telephone Number	:	260-426-8117
Fax Number	:

Provider Business Practice Location Address
First Line	:	7926 W JEFFERSON BLVD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-4140
Country	:	US
Telephone Number	:	260-426-8117
Fax Number	:

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

Provider Enumeration Date	:	09/24/2020
Last Update Date	:	11/19/2024

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