Provider Demographics
NPI:1992307268
Name:HULLUM, BERTHA L
Entity type:Individual
Prefix:
First Name:BERTHA
Middle Name:L
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 1:980 FREDERICK BLVD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44320-2647
Mailing Address - Country:US
Mailing Address - Phone:330-212-2031
Mailing Address - Fax:234-208-9787
Practice Address - Street 1:980 FREDERICK BLVD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44320-2647
Practice Address - Country:US
Practice Address - Phone:330-212-2031
Practice Address - Fax:231-208-9787
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care