Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | RN184471 NP | GA |
NPI | 1083714968 |
---|---|
Provider Name | Ashlie Lynn Pullen |
First Address | Warner Robins, GA 31093-3074 |
Second Address | Warner Robins, GA 31093-3074 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2006 |
Last Update Date | 18/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Q76365 | (02) |