Provider Demographics
NPI:1619244704
Name:HULSEBOS, HANS JEFFREY (MD, MS)
Entity Type:Individual
Prefix:DR
First Name:HANS
Middle Name:JEFFREY
Last Name:HULSEBOS
Suffix:
Gender:M
Credentials:MD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9436 DEER LODGE LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-6961
Mailing Address - Country:US
Mailing Address - Phone:401-862-4597
Mailing Address - Fax:
Practice Address - Street 1:3150 N TENAYA WAY
Practice Address - Street 2:480
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0443
Practice Address - Country:US
Practice Address - Phone:401-862-4597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-17
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ46768208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice