Healthcare Provider Details

I. General information

NPI: 1720726169
Provider Name (Legal Business Name): PATRICIA SUSAN PULS REGISTER NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2022
Last Update Date: 05/25/2022
Certification Date: 05/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3355 CHAD DR
EUGENE OR
97408-7428
US

IV. Provider business mailing address

3355 CHAD DR
EUGENE OR
97408-7428
US

V. Phone/Fax

Practice location:
  • Phone: 541-607-0897
  • Fax: 541-607-7474
Mailing address:
  • Phone: 541-607-0897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number202104574
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: