Provider Demographics
NPI:1144285594
Name:HULSMAN, LAURIE (DO)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:HULSMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 40
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:NC
Mailing Address - Zip Code:27983-0040
Mailing Address - Country:US
Mailing Address - Phone:252-794-6775
Mailing Address - Fax:979-543-2205
Practice Address - Street 1:1403 S KING ST
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:NC
Practice Address - Zip Code:27983-9666
Practice Address - Country:US
Practice Address - Phone:252-794-6775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2884207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00326642OtherRAILROAD MEDICARE
TX8V0920OtherBCBS
TX179826601Medicaid
TX179826601Medicaid
TXH24213Medicare UPIN