Provider Demographics
NPI:1568166882
Name:HULSE, TESSA ANN
Entity Type:Individual
Prefix:
First Name:TESSA
Middle Name:ANN
Last Name:HULSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:781 BLACK OAK DR STE 102
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-9501
Mailing Address - Country:US
Mailing Address - Phone:541-789-5211
Mailing Address - Fax:
Practice Address - Street 1:781 BLACK OAK DR STE 102
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-9501
Practice Address - Country:US
Practice Address - Phone:541-789-4995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-29
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach