Provider Demographics
NPI:1962673582
Name:GULMAN, BETTYE JILL (OTR)
Entity Type:Individual
Prefix:MS
First Name:BETTYE
Middle Name:JILL
Last Name:GULMAN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1702
Mailing Address - Street 2:
Mailing Address - City:MAKAWAO
Mailing Address - State:HI
Mailing Address - Zip Code:96768-1702
Mailing Address - Country:US
Mailing Address - Phone:808-572-4822
Mailing Address - Fax:
Practice Address - Street 1:2055 OLINDA RD
Practice Address - Street 2:
Practice Address - City:MAKAWAO
Practice Address - State:HI
Practice Address - Zip Code:96768-7130
Practice Address - Country:US
Practice Address - Phone:808-572-4822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-24
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIOT - 821302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization