Provider Demographics
NPI:1689282188
Name:PULLOM, DOWANDA DENISE (FNP)
Entity Type:Individual
Prefix:
First Name:DOWANDA
Middle Name:DENISE
Last Name:PULLOM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 MANGUM AVE
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:AL
Mailing Address - Zip Code:36701-4725
Mailing Address - Country:US
Mailing Address - Phone:334-349-0530
Mailing Address - Fax:
Practice Address - Street 1:3700 CAHABA BEACH RD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-5225
Practice Address - Country:US
Practice Address - Phone:205-319-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-21
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-105901363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner