Provider Demographics
NPI:1235668443
Name:HULL-MALNOSKE, AIMEE M
Entity type:Individual
Prefix:
First Name:AIMEE
Middle Name:M
Last Name:HULL-MALNOSKE
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 1:22211 BROWNIE DR
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-9520
Mailing Address - Country:US
Mailing Address - Phone:907-538-9809
Mailing Address - Fax:
Practice Address - Street 1:22211 BROWNIE DR
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-9520
Practice Address - Country:US
Practice Address - Phone:907-538-9809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1055177174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist