Provider Demographics
NPI:1588046759
Name:HULTS, CASONDRA LEE
Entity type:Individual
Prefix:
First Name:CASONDRA
Middle Name:LEE
Last Name:HULTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CASONDRA
Other - Middle Name:LEE
Other - Last Name:RICHEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:27268 S HORNER RD
Mailing Address - Street 2:
Mailing Address - City:ESTACADA
Mailing Address - State:OR
Mailing Address - Zip Code:97023-9458
Mailing Address - Country:US
Mailing Address - Phone:503-867-5581
Mailing Address - Fax:
Practice Address - Street 1:27268 S HORNER RD
Practice Address - Street 2:
Practice Address - City:ESTACADA
Practice Address - State:OR
Practice Address - Zip Code:97023-9458
Practice Address - Country:US
Practice Address - Phone:503-867-5581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-24
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program