Basic Information
| Provider Information | |||||||||
| NPI: | 1497964167 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HULL-GROMMESH | ||||||||
| FirstName: | LORI | ||||||||
| MiddleName: | DENISE | ||||||||
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| Credential: | RN MSN CCRN ACNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 630 E STAR CT | ||||||||
| Address2: | |||||||||
| City: | MONTROSE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 814016702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702521020 | ||||||||
| FaxNumber: | 9702521041 | ||||||||
| Practice Location | |||||||||
| Address1: | 630 E STAR CT | ||||||||
| Address2: | |||||||||
| City: | MONTROSE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 814016702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702521020 | ||||||||
| FaxNumber: | 9702521041 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2007 | ||||||||
| LastUpdateDate: | 04/26/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2100X | 656611 | TX | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care | 363LA2100X | C-APN.0004052-C-NP | CO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No ID Information.