Provider Demographics
NPI:1578520557
Name:PULASKI, SANDRA B (APRN)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:B
Last Name:PULASKI
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MISS
Other - First Name:SANDRA
Other - Middle Name:JEAN
Other - Last Name:BRUBAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:494 MAXWELL RD
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-3726
Mailing Address - Country:US
Mailing Address - Phone:770-883-3203
Mailing Address - Fax:
Practice Address - Street 1:2550 WINDY HILL RD SE
Practice Address - Street 2:SUITE 115
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-8665
Practice Address - Country:US
Practice Address - Phone:770-980-1818
Practice Address - Fax:770-980-1873
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAR137019163WG0000X, 363LA2200X, 363L00000X
FL2045242163WG0000X, 363LA2200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner