Provider Demographics
NPI:1831659960
Name:RULL, LOANN NGUYEN
Entity Type:Individual
Prefix:
First Name:LOANN
Middle Name:NGUYEN
Last Name:RULL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33495 FOLLMAN WAY
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92530-6103
Mailing Address - Country:US
Mailing Address - Phone:714-235-3705
Mailing Address - Fax:
Practice Address - Street 1:33495 FOLLMAN WAY
Practice Address - Street 2:
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530-6103
Practice Address - Country:US
Practice Address - Phone:714-235-3705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-24
Last Update Date:2019-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA264708164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse