Basic Information
| Provider Information | |||||||||
| NPI: | 1841480928 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HULSHOFF | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | |||||||||
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| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5320 S RAINBOW BLVD STE 182 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891181896 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7024794886 | ||||||||
| FaxNumber: | 7026716883 | ||||||||
| Practice Location | |||||||||
| Address1: | 5320 S RAINBOW BLVD STE 182 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 89118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7024794886 | ||||||||
| FaxNumber: | 7026716883 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2007 | ||||||||
| LastUpdateDate: | 07/26/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 0102202168 | VA | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | DO2417 | NV | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 0116018903 | 05 | VA | MEDICAID |