Provider Demographics
NPI:1174811046
Name:CHANG HULL, ROSE KIM (NP)
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:KIM
Last Name:CHANG HULL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1524 W LACEY BLVD
Mailing Address - Street 2:STE 101
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-5990
Mailing Address - Country:US
Mailing Address - Phone:559-537-0305
Mailing Address - Fax:559-537-0307
Practice Address - Street 1:2823 FRESNO ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93721-1324
Practice Address - Country:US
Practice Address - Phone:559-499-6439
Practice Address - Fax:559-499-6441
Is Sole Proprietor?:No
Enumeration Date:2011-07-13
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN718940163W00000X
CANP20843363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse