Basic Information
| Provider Information | |||||||||
| NPI: | 1750581617 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HULSE | ||||||||
| FirstName: | TINA | ||||||||
| MiddleName: | I | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | PA-C | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 415 JEFFERSON ST NORTH | ||||||||
| Address2: | TRI-COUNTY HOSPITAL | ||||||||
| City: | WADENA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 564821296 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2186313510 | ||||||||
| FaxNumber: | 2186317503 | ||||||||
| Practice Location | |||||||||
| Address1: | 4 DEERWOOD AVE NW | ||||||||
| Address2: | TRI-COUNTY HEALTH CARE WADENA CLINIC | ||||||||
| City: | WADENA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 564821296 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2186311360 | ||||||||
| FaxNumber: | 2186317507 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2007 | ||||||||
| LastUpdateDate: | 02/23/2016 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 10267 | MN | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.