Provider Demographics
NPI:1346320702
Name:HULL, PATRICIA T
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:T
Last Name:HULL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:T
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:802 KENYON RD
Mailing Address - Street 2:UNITYPOINT AT HOME
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-5740
Mailing Address - Country:US
Mailing Address - Phone:515-574-6416
Mailing Address - Fax:
Practice Address - Street 1:802 KENYON RD
Practice Address - Street 2:UNITYPOINT AT HOME
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-5740
Practice Address - Country:US
Practice Address - Phone:515-574-6416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA014471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN07466OtherWELLMARK BCBS
IN10852OtherMIDLANDS CHOICE
IA0159608Medicaid
IAS32845Medicare UPIN
IN07466OtherWELLMARK BCBS