Provider Demographics
NPI:1972645992
Name:HULSE, BETTY ANN (PAC)
Entity Type:Individual
Prefix:MS
First Name:BETTY
Middle Name:ANN
Last Name:HULSE
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:MS
Other - First Name:BETTY
Other - Middle Name:ANN
Other - Last Name:SCHEMPP HULSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:422 PRENTIS AVE
Mailing Address - Street 2:
Mailing Address - City:VERMILLION
Mailing Address - State:SD
Mailing Address - Zip Code:57069-2516
Mailing Address - Country:US
Mailing Address - Phone:605-624-0217
Mailing Address - Fax:605-668-3460
Practice Address - Street 1:3515 BROADWAY AVE.
Practice Address - Street 2:
Practice Address - City:YANKTON
Practice Address - State:SD
Practice Address - Zip Code:57078-7600
Practice Address - Country:US
Practice Address - Phone:605-668-3100
Practice Address - Fax:605-668-3460
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0218283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital