Provider Demographics
NPI:1265476139
Name:PULLEN, DAWN KIM (CRNP)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:KIM
Last Name:PULLEN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12415 PRESERVE WAY
Mailing Address - Street 2:
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136-3533
Mailing Address - Country:US
Mailing Address - Phone:410-848-2170
Mailing Address - Fax:410-876-2270
Practice Address - Street 1:1130 BALTIMORE BLVD
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-7098
Practice Address - Country:US
Practice Address - Phone:410-848-2170
Practice Address - Fax:410-876-2270
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR072251363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCR5130004OtherCAREFIRST B/C B/S BLUE CH
MD52430408OtherCAREFIRST B/C B/S
DCR5130004OtherCAREFIRST B/C B/S BLUE CH
MDR029702Medicare UPIN