Provider Demographics
NPI:1659338689
Name:PITTMAN, ETHEL LEE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:ETHEL
Middle Name:LEE
Last Name:PITTMAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:ETHEL
Other - Middle Name:LEE
Other - Last Name:WRIGHT HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:2121A BELLEVUE RD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021
Mailing Address - Country:US
Mailing Address - Phone:478-272-1190
Mailing Address - Fax:478-275-6509
Practice Address - Street 1:2121A BELLEVUE RD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021
Practice Address - Country:US
Practice Address - Phone:478-272-1190
Practice Address - Fax:478-275-6509
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN060456164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse