MEDICARE: DONNA A PULLMAN CRNFA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WR0006X	Registered Nurse First Assistant		IL

General Provider Information

NPI Number	:	1730262932
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONNA A PULLMAN CRNFA

Provider Business Mailing Address
First Line	:	3315 ASPEN CT
Second Line	:
City	:	JOLIET
State	:	IL
Zip	:	60431-4903
Country	:	US
Telephone Number	:	815-741-0375
Fax Number	:	815-741-9895

Provider Business Practice Location Address
First Line	:	3315 ASPEN CT
Second Line	:
City	:	JOLIET
State	:	IL
Zip	:	60431-4903
Country	:	US
Telephone Number	:	815-741-0375
Fax Number	:	815-741-9895

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	07/08/2007

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