Provider Demographics
NPI:1780947762
Name:PULIDO, KRISTELLE OLANKA
Entity type:Individual
Prefix:MISS
First Name:KRISTELLE
Middle Name:OLANKA
Last Name:PULIDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24221 90TH AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEROSE
Mailing Address - State:NY
Mailing Address - Zip Code:11426-1115
Mailing Address - Country:US
Mailing Address - Phone:718-831-1979
Mailing Address - Fax:
Practice Address - Street 1:24221 90TH AVE
Practice Address - Street 2:
Practice Address - City:BELLEROSE
Practice Address - State:NY
Practice Address - Zip Code:11426-1115
Practice Address - Country:US
Practice Address - Phone:718-831-1979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-24
Last Update Date:2012-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF3058551363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner