Provider Demographics
NPI:1144621749
Name:HULL, KATHLEEN (PHD, RN, FNP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:HULL
Suffix:
Gender:F
Credentials:PHD, RN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 E BROADWAY RD STE B
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-2019
Mailing Address - Country:US
Mailing Address - Phone:480-844-0163
Mailing Address - Fax:
Practice Address - Street 1:465 E BROADWAY RD STE B
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-2019
Practice Address - Country:US
Practice Address - Phone:480-844-0163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-15
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN075604163WG0000X
AZAP0479163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice