Healthcare Provider Details

I. General information

NPI: 1265476139
Provider Name (Legal Business Name): DAWN KIM PULLEN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 BALTIMORE BLVD
WESTMINSTER MD
21157-7098
US

IV. Provider business mailing address

12415 PRESERVE WAY
REISTERSTOWN MD
21136-3533
US

V. Phone/Fax

Practice location:
  • Phone: 410-848-2170
  • Fax: 410-876-2270
Mailing address:
  • Phone: 410-848-2170
  • Fax: 410-876-2270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberR072251
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: