Provider Demographics
NPI:1730448820
Name:PULLEN, SHAWN (LPN)
Entity type:Individual
Prefix:MRS
First Name:SHAWN
Middle Name:
Last Name:PULLEN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6420 WESTFORD RD
Mailing Address - Street 2:
Mailing Address - City:TROTWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45426-1121
Mailing Address - Country:US
Mailing Address - Phone:937-238-6446
Mailing Address - Fax:
Practice Address - Street 1:6420 WESTFORD RD
Practice Address - Street 2:
Practice Address - City:TROTWOOD
Practice Address - State:OH
Practice Address - Zip Code:45426-1121
Practice Address - Country:US
Practice Address - Phone:937-238-6446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-09
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN143592164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse