Basic Information
| Provider Information | |||||||||
| NPI: | 1912201013 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HULL | ||||||||
| FirstName: | CHARLI | ||||||||
| MiddleName: | YVONNE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 27501 SKAGG CITY RD | ||||||||
| Address2: | |||||||||
| City: | TECUMSEH | ||||||||
| State: | OK | ||||||||
| PostalCode: | 748738244 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4059973249 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1102 W MACARTHUR ST | ||||||||
| Address2: | |||||||||
| City: | SHAWNEE | ||||||||
| State: | OK | ||||||||
| PostalCode: | 748041743 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4058788110 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2011 | ||||||||
| LastUpdateDate: | 01/04/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WL0100X | 67526 | OK | Y | Nursing Service Providers | Registered Nurse | Lactation Consultant |
No ID Information.