Provider Demographics
NPI:1033983630
Name:PULTZ, RICHELLE
Entity Type:Individual
Prefix:
First Name:RICHELLE
Middle Name:
Last Name:PULTZ
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 1:2836 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-4334
Mailing Address - Country:US
Mailing Address - Phone:503-707-6984
Mailing Address - Fax:
Practice Address - Street 1:2836 FRONT ST
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-4334
Practice Address - Country:US
Practice Address - Phone:503-707-6984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No174N00000XOther Service ProvidersLactation Consultant, Non-RN
No175L00000XOther Service ProvidersHomeopath