Provider Demographics
NPI:1710086442
Name:PULLIN, MELISSA I (FNP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:PULLIN
Suffix:I
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 1:3669 COUNTRYSIDE LN
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:NY
Mailing Address - Zip Code:14505-9781
Mailing Address - Country:US
Mailing Address - Phone:315-926-3777
Mailing Address - Fax:
Practice Address - Street 1:3669 COUNTRYSIDE LN
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:NY
Practice Address - Zip Code:14505-9781
Practice Address - Country:US
Practice Address - Phone:315-926-7733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY334933363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02809130Medicaid
NY02809130Medicaid