Provider Demographics
NPI:1902537442
Name:HULL, EVONNDA
Entity Type:Individual
Prefix:
First Name:EVONNDA
Middle Name:
Last Name:HULL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22675 ANOKA RD
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92308-5436
Mailing Address - Country:US
Mailing Address - Phone:760-486-0216
Mailing Address - Fax:760-247-8920
Practice Address - Street 1:22675 ANOKA RD
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92308-5436
Practice Address - Country:US
Practice Address - Phone:760-486-0216
Practice Address - Fax:760-247-8920
Is Sole Proprietor?:No
Enumeration Date:2022-06-23
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist