Basic Information
| Provider Information | |||||||||
| NPI: | 1821364530 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HULLIHAN | ||||||||
| FirstName: | MARTHA | ||||||||
| MiddleName: | JANE | ||||||||
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| Credential: | BSN,RN-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1400 BLACKHORSE HILL RD | ||||||||
| Address2: | PRIMARY CARE | ||||||||
| City: | COATESVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193202040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6103847711 | ||||||||
| FaxNumber: | 6104662271 | ||||||||
| Practice Location | |||||||||
| Address1: | 1400 BLACKHORSE HILL RD | ||||||||
| Address2: | PRIMARY CARE | ||||||||
| City: | COATESVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193202040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6103847711 | ||||||||
| FaxNumber: | 6104662271 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2012 | ||||||||
| LastUpdateDate: | 03/27/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN179768L | PA | Y | Nursing Service Providers | Registered Nurse |
No ID Information.