Provider Demographics
NPI:1417415597
Name:HULSE, GRACE ELIZABETH
Entity Type:Individual
Prefix:MRS
First Name:GRACE
Middle Name:ELIZABETH
Last Name:HULSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GRACIE
Other - Middle Name:ELIZABETH
Other - Last Name:HULSE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 599
Mailing Address - Street 2:
Mailing Address - City:DORAN
Mailing Address - State:VA
Mailing Address - Zip Code:24612-0599
Mailing Address - Country:US
Mailing Address - Phone:276-971-9797
Mailing Address - Fax:844-303-1337
Practice Address - Street 1:127 AVALON STREET
Practice Address - Street 2:
Practice Address - City:DORAN
Practice Address - State:VA
Practice Address - Zip Code:24612
Practice Address - Country:US
Practice Address - Phone:276-971-9797
Practice Address - Fax:844-303-1337
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-07
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle