Provider Demographics
NPI:1700986114
Name:PUGH, DELLA DARLENE (RN)
Entity type:Individual
Prefix:MRS
First Name:DELLA
Middle Name:DARLENE
Last Name:PUGH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 382
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:IL
Mailing Address - Zip Code:62931-0382
Mailing Address - Country:US
Mailing Address - Phone:618-285-6370
Mailing Address - Fax:618-285-3597
Practice Address - Street 1:JUNCTION 34 & RTE 146
Practice Address - Street 2:
Practice Address - City:ROSICLARE
Practice Address - State:IL
Practice Address - Zip Code:62982
Practice Address - Country:US
Practice Address - Phone:618-285-3511
Practice Address - Fax:618-285-3597
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
332B00000XOtherPROVIDER TAXONOMY NUMBER
332B00000XOtherPROVIDER TAXONOMY NUMBER