Provider Demographics
NPI:1114676335
Name:HULL, MALLORI LYNN (CNP PEDIATRICS)
Entity Type:Individual
Prefix:MRS
First Name:MALLORI
Middle Name:LYNN
Last Name:HULL
Suffix:
Gender:F
Credentials:CNP PEDIATRICS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1712 OVERLOOK AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44509-2101
Mailing Address - Country:US
Mailing Address - Phone:330-423-3584
Mailing Address - Fax:
Practice Address - Street 1:1712 OVERLOOK AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44509-2101
Practice Address - Country:US
Practice Address - Phone:330-423-3584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-23
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0027345363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics