Provider Demographics
NPI:1760015804
Name:HULSEY, VIVIAN MARIE (LPN)
Entity Type:Individual
Prefix:
First Name:VIVIAN
Middle Name:MARIE
Last Name:HULSEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6861 12 MILE RD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:49029-9755
Mailing Address - Country:US
Mailing Address - Phone:269-578-6081
Mailing Address - Fax:
Practice Address - Street 1:6861 12 MILE RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MI
Practice Address - Zip Code:49029-9755
Practice Address - Country:US
Practice Address - Phone:269-578-6081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-18
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703078187164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse