Provider Demographics
NPI:1699470518
Name:MICKEL-HULSE, SAMUEL ALLEN
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:ALLEN
Last Name:MICKEL-HULSE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 KNOX WAY
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27516-6610
Mailing Address - Country:US
Mailing Address - Phone:984-215-5900
Mailing Address - Fax:
Practice Address - Street 1:118 KNOX WAY
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27516-6610
Practice Address - Country:US
Practice Address - Phone:984-215-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-31
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program