Healthcare Provider Details

I. General information

NPI: 1801615349
Provider Name (Legal Business Name): MARIANNE FRANCES PULLAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2024
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

533 VICOT WAY UNIT H
FORT COLLINS CO
80524-4990
US

IV. Provider business mailing address

533 VICOT WAY UNIT H
FORT COLLINS CO
80524-4990
US

V. Phone/Fax

Practice location:
  • Phone: 970-214-7550
  • Fax:
Mailing address:
  • Phone: 970-214-7550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number0082523
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: