Provider Demographics
NPI:1528482387
Name:PULLIAM, WINONA R
Entity type:Individual
Prefix:
First Name:WINONA
Middle Name:R
Last Name:PULLIAM
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 1:2953 CIRCLING HAWK ST
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81503-8306
Mailing Address - Country:US
Mailing Address - Phone:970-623-2980
Mailing Address - Fax:
Practice Address - Street 1:2953 CIRCLING HAWK ST
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81503-8306
Practice Address - Country:US
Practice Address - Phone:970-623-2980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-13
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN0160748163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CORN0160748OtherRN LICENSE