Provider Demographics
NPI:1801615349
Name:PULLAM, MARIANNE FRANCES
Entity type:Individual
Prefix:
First Name:MARIANNE
Middle Name:FRANCES
Last Name:PULLAM
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 1:533 VICOT WAY UNIT H
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-4990
Mailing Address - Country:US
Mailing Address - Phone:970-214-7550
Mailing Address - Fax:
Practice Address - Street 1:533 VICOT WAY UNIT H
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-4990
Practice Address - Country:US
Practice Address - Phone:970-214-7550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0082523163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management