Healthcare Provider Details

I. General information

NPI: 1124164454
Provider Name (Legal Business Name): SYLVIA JOSEPHINE TULLER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SIMON'S ROCK COLLEGE 84 ALFORD ROAD
GREAT BARRINGTON MA
01230
US

IV. Provider business mailing address

35 PARKVIEW TER
LEE MA
01238-9419
US

V. Phone/Fax

Practice location:
  • Phone: 413-528-7419
  • Fax: 413-528-7358
Mailing address:
  • Phone: 413-243-9165
  • Fax: 413-528-7358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LS0200X
TaxonomySchool Nurse Practitioner
License Number109359
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: