MEDICARE: MRS. SUSAN ELLEN PULEO RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN9190053	FL

General Provider Information

NPI Number	:	1255522017
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUSAN ELLEN PULEO RN

Provider Business Mailing Address
First Line	:	7857 UMBERTO CT
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34114-2686
Country	:	US
Telephone Number	:	239-793-2926
Fax Number	:	239-793-2335

Provider Business Practice Location Address
First Line	:	5935 CORNERSTONE CT W
Second Line	:	#300
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-3737
Country	:	US
Telephone Number	:	866-687-7390
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2007
Last Update Date	:	08/07/2007

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