Provider Demographics
NPI:1891330270
Name:HULLUM, LAURA RUTH ANNE
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:RUTH ANNE
Last Name:HULLUM
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 1:7050 COUNTY ROAD 334
Mailing Address - Street 2:
Mailing Address - City:BLANKET
Mailing Address - State:TX
Mailing Address - Zip Code:76432-6419
Mailing Address - Country:US
Mailing Address - Phone:325-203-0023
Mailing Address - Fax:
Practice Address - Street 1:2585 S DANVILLE DR
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79605-6414
Practice Address - Country:US
Practice Address - Phone:325-690-0583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-09
Last Update Date:2019-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX844343163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management