Provider Demographics
NPI:1396194858
Name:HULL, MITTIE TYSHAWN (LVN)
Entity Type:Individual
Prefix:
First Name:MITTIE
Middle Name:TYSHAWN
Last Name:HULL
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44040 32ND ST W
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93536-6178
Mailing Address - Country:US
Mailing Address - Phone:310-425-5839
Mailing Address - Fax:
Practice Address - Street 1:44040 32ND ST W
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93536-6178
Practice Address - Country:US
Practice Address - Phone:310-425-5839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-06
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN230956164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse