Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 71003247A | IN |
Y | 363LA2200X | Nurse Practitioner - Adult Health | 71003247A | IN |
NPI | 1013230911 |
---|---|
Provider Name | Amber N Gullion |
First Address | Pittsburgh, PA 15251-5859 |
Second Address | Fort Wayne, IN 46815 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2010 |
Last Update Date | 22/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200986240 | (05) | IN |
M38018009 | MEDICARE (01) | IN |