Provider Demographics
NPI:1285810788
Name:HULL, MARY A (DIETITAN)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:A
Last Name:HULL
Suffix:
Gender:F
Credentials:DIETITAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 PROVIDENCE DR
Mailing Address - Street 2:SUITE 02
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4671
Mailing Address - Country:US
Mailing Address - Phone:907-375-5200
Mailing Address - Fax:907-375-5201
Practice Address - Street 1:3300 PROVIDENCE DR
Practice Address - Street 2:SUITE 02
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4671
Practice Address - Country:US
Practice Address - Phone:907-375-5200
Practice Address - Fax:907-375-5201
Is Sole Proprietor?:No
Enumeration Date:2008-01-14
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK62133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered