Provider Demographics
NPI:1073101101
Name:PULLEY, LEAH
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:PULLEY
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 1:1824 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:EAST SAINT LOUIS
Mailing Address - State:IL
Mailing Address - Zip Code:62207-2252
Mailing Address - Country:US
Mailing Address - Phone:269-425-2813
Mailing Address - Fax:
Practice Address - Street 1:1824 MARKET ST
Practice Address - Street 2:
Practice Address - City:EAST SAINT LOUIS
Practice Address - State:IL
Practice Address - Zip Code:62207-2252
Practice Address - Country:US
Practice Address - Phone:269-425-2813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-05
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty