Provider Demographics
NPI:1417108119
Name:PUHALLA, EMILY (NURSE)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:PUHALLA
Suffix:
Gender:F
Credentials:NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 BURKHARDT AVE
Mailing Address - Street 2:
Mailing Address - City:BADEN
Mailing Address - State:PA
Mailing Address - Zip Code:15005-1646
Mailing Address - Country:US
Mailing Address - Phone:724-869-2864
Mailing Address - Fax:
Practice Address - Street 1:599 NORWOOD DR
Practice Address - Street 2:
Practice Address - City:WAMPUM
Practice Address - State:PA
Practice Address - Zip Code:16157-2505
Practice Address - Country:US
Practice Address - Phone:724-891-1274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-01
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN111815L163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse