Provider Demographics
NPI:1811695133
Name:HULL, CANDACE
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:HULL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 N 4148 RD
Mailing Address - Street 2:
Mailing Address - City:SOPER
Mailing Address - State:OK
Mailing Address - Zip Code:74759-4027
Mailing Address - Country:US
Mailing Address - Phone:580-579-0869
Mailing Address - Fax:
Practice Address - Street 1:424 N 4148 RD
Practice Address - Street 2:
Practice Address - City:SOPER
Practice Address - State:OK
Practice Address - Zip Code:74759-4027
Practice Address - Country:US
Practice Address - Phone:580-579-0869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-16
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula