Healthcare Provider Details

I. General information

NPI: 1710086442
Provider Name (Legal Business Name): MELISSA PULLIN I FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/05/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3669 COUNTRYSIDE LN
MARION NY
14505-9781
US

IV. Provider business mailing address

3669 COUNTRYSIDE LN
MARION NY
14505-9781
US

V. Phone/Fax

Practice location:
  • Phone: 315-926-7733
  • Fax:
Mailing address:
  • Phone: 315-926-3777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number334933
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: