Provider Demographics
NPI:1588078281
Name:HULVEY, MAEANN
Entity type:Individual
Prefix:
First Name:MAEANN
Middle Name:
Last Name:HULVEY
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 1:37119 VILLAGE 37
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-5608
Mailing Address - Country:US
Mailing Address - Phone:937-369-4304
Mailing Address - Fax:
Practice Address - Street 1:2220 GONZALES ROAD, SUITE 102
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93036-3707
Practice Address - Country:US
Practice Address - Phone:937-369-4304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-20
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN322244163WC0400X
CARN3222244171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No163WC0400XNursing Service ProvidersRegistered NurseCase Management