Provider Demographics
NPI:1578053195
Name:PULLING, WANDA D (LVN)
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:D
Last Name:PULLING
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:WANDA
Other - Middle Name:D
Other - Last Name:NELSON-PULLING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LVN
Mailing Address - Street 1:2531 FM 1960 RD # 110
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77073-2505
Mailing Address - Country:US
Mailing Address - Phone:281-323-8893
Mailing Address - Fax:
Practice Address - Street 1:2531 FM 1960 RD # 110
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77073-2505
Practice Address - Country:US
Practice Address - Phone:281-323-8893
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-18
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX117147164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse