Provider Demographics
NPI:1285130831
Name:PULLIAMS, NANCY RUTH (RN)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:RUTH
Last Name:PULLIAMS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3960 ABBIE COVE DR E
Mailing Address - Street 2:
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110-1500
Mailing Address - Country:US
Mailing Address - Phone:231-740-3511
Mailing Address - Fax:
Practice Address - Street 1:3960 ABBIE COVE DR E
Practice Address - Street 2:
Practice Address - City:CANAL WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:43110-1500
Practice Address - Country:US
Practice Address - Phone:231-740-3511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-03
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN311530163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice