Basic Information
| Provider Information | |||||||||
| NPI: | 1952796575 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HULL | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | HOUSTON | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 701 SHENANDOAH DR | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 384016120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9317974952 | ||||||||
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| Practice Location | |||||||||
| Address1: | 811 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | MOUNT PLEASANT | ||||||||
| State: | TN | ||||||||
| PostalCode: | 384741017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9313793229 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2015 | ||||||||
| LastUpdateDate: | 03/31/2015 | ||||||||
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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 | 163W00000X | 180607 | TN | N | Nursing Service Providers | Registered Nurse | 363LF0000X | 19803 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.