Provider Demographics
NPI:1841480928
Name:HULSHOFF, JOHN (DO)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:HULSHOFF
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5320 S RAINBOW BLVD STE 182
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-1896
Mailing Address - Country:US
Mailing Address - Phone:702-479-4886
Mailing Address - Fax:702-671-6883
Practice Address - Street 1:5320 S RAINBOW BLVD STE 182
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118
Practice Address - Country:US
Practice Address - Phone:702-479-4886
Practice Address - Fax:702-671-6883
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102202168207V00000X
NVDO2417207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0116018903Medicaid
VAV V3634BMedicare PIN
VA0116018903Medicaid