1346308780 NPI number — MRS. TAMMY L TRUDELL HULL LMSW

Table of content: MRS. TAMMY L TRUDELL HULL LMSW (NPI 1346308780)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346308780 NPI number — MRS. TAMMY L TRUDELL HULL LMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TRUDELL HULL
Provider First Name:
TAMMY
Provider Middle Name:
L
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TRUDELL
Provider Other First Name:
TAMMY
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMSW
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1346308780
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 339
Provider Second Line Business Mailing Address:
402 THORNTON ST
Provider Business Mailing Address City Name:
MIDDLEVILLE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49333
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
269-795-2243
Provider Business Mailing Address Fax Number:
269-795-5315

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
402 THORNTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDDLEVILLE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49333
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
269-795-2243
Provider Business Practice Location Address Fax Number:
269-795-5315
Provider Enumeration Date:
12/05/2006

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: 104100000X , with the licence number:  L797306 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7157369 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8008966970 . This is a "BCBS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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