Provider Demographics
NPI:1043483738
Name:PULLIAM, ANGELA TRAUTWEIN (N/A)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:TRAUTWEIN
Last Name:PULLIAM
Suffix:
Gender:F
Credentials:N/A
Other - Prefix:MRS
Other - First Name:ANGELA
Other - Middle Name:SUE
Other - Last Name:TRAUTWEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:312 HERMITAGE DR
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40601-2936
Mailing Address - Country:US
Mailing Address - Phone:502-229-0468
Mailing Address - Fax:
Practice Address - Street 1:312 HERMITAGE DR
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-2936
Practice Address - Country:US
Practice Address - Phone:502-229-0468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker