Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 214246-1 | NY |
NPI | 1083659106 |
---|---|
Provider Name | Dr. Tamara Ann Prull |
First Address | Williamson, NY 14589-9352 |
Second Address | Wellsville, NY 14895-1150 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2006 |
Last Update Date | 26/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000527179003 | BCBS (01) | NY |
02390949 | (05) | NY |
H61811 | (02) | NY |
P00203836 | RRM LEGACY (01) | NY |
P00393355 | RAILROAD (01) | NY |