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General NPI Number Information
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NPI Number | 1235792177
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Entity Type | Individual
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Provider Name | ALEXA BREANNE PULLEN RD
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Gender | Female
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Dates
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Enumeration Date | 04/16/2019
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | 19239 DARBY RD
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City | EAGLE RIVER
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State | AK
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Zip | 99577
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Country | US
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Telephone | 907-854-4482
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Fax |
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Provider Business Mailing Address
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Address Line | 12110 BUSINESS BLVD STE 6 PMB 189
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City | EAGLE RIVER
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State | AK
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Zip | 99577-7798
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Country | US
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Telephone | 907-854-4482
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number | 145169
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License Number State | AK
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | DT86980
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 229812
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License Number State | AK
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