1023574688 NPI number — BETH A HULME RN

Table of content: BETH A HULME RN (NPI 1023574688)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023574688 NPI number — BETH A HULME RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HULME
Provider First Name:
BETH
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HACKETT
Provider Other First Name:
BETH
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1023574688
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/08/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7833 WALKER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LE ROY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14482-8959
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7833 WALKER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LE ROY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14482-8959
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-813-6883
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/19/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 164W00000X , with the licence number:  330857 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163W00000X , with the licence number: 817665 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 817665 . This is a "REGISTERED NURSE LICENSE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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