Healthcare Provider Details

I. General information

NPI: 1063852366
Provider Name (Legal Business Name): BRIDGETTE PULLIS PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2013
Last Update Date: 07/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6901 BERTNER AVE SUITE 729
HOUSTON TX
77030-3901
US

IV. Provider business mailing address

2730 HOLLY HALL ST APT I
HOUSTON TX
77054-4212
US

V. Phone/Fax

Practice location:
  • Phone: 713-500-2189
  • Fax: 713-500-2142
Mailing address:
  • Phone: 713-500-2189
  • Fax: 713-500-2142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License Number557155
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: