Provider Demographics
NPI:1619063252
Name:HULM, MARDONNA R (CNP)
Entity Type:Individual
Prefix:
First Name:MARDONNA
Middle Name:R
Last Name:HULM
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:MARDI
Other - Middle Name:R
Other - Last Name:HULM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CNP
Mailing Address - Street 1:16060 226TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW UNDERWOOD
Mailing Address - State:SD
Mailing Address - Zip Code:57761-6124
Mailing Address - Country:US
Mailing Address - Phone:605-347-2511
Mailing Address - Fax:605-720-7286
Practice Address - Street 1:113 COMANCHE RD
Practice Address - Street 2:
Practice Address - City:FORT MEADE
Practice Address - State:SD
Practice Address - Zip Code:57741-1002
Practice Address - Country:US
Practice Address - Phone:605-347-2451
Practice Address - Fax:605-720-7286
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDRO18353363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health