Provider Demographics
NPI:1326227836
Name:PULLIAM, TAMRA WILLIS (NA)
Entity Type:Individual
Prefix:
First Name:TAMRA
Middle Name:WILLIS
Last Name:PULLIAM
Suffix:
Gender:F
Credentials:NA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24248 GOLDEN MIST DR
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-5305
Mailing Address - Country:US
Mailing Address - Phone:951-894-4821
Mailing Address - Fax:951-894-4821
Practice Address - Street 1:24248 GOLDEN MIST DR
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-5305
Practice Address - Country:US
Practice Address - Phone:951-894-4821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-31
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide