Provider Demographics
NPI:1619942166
Name:PULLIAM, LOREN L (CRNA)
Entity Type:Individual
Prefix:MS
First Name:LOREN
Middle Name:L
Last Name:PULLIAM
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:368 DOROTHY DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15235-1830
Mailing Address - Country:US
Mailing Address - Phone:412-244-1832
Mailing Address - Fax:
Practice Address - Street 1:368 DOROTHY DR
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15235-1830
Practice Address - Country:US
Practice Address - Phone:412-244-1832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN282102L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA806026FEVMedicare ID - Type Unspecified
PAS10447Medicare UPIN