Provider Demographics
NPI:1932147592
Name:PULVER, RHONDA (PA)
Entity type:Individual
Prefix:
First Name:RHONDA
Middle Name:
Last Name:PULVER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18209 EULA MAE PKWY
Mailing Address - Street 2:
Mailing Address - City:CARLYLE
Mailing Address - State:IL
Mailing Address - Zip Code:62231-6407
Mailing Address - Country:US
Mailing Address - Phone:618-594-3671
Mailing Address - Fax:
Practice Address - Street 1:18209 EULA MAE PKWY
Practice Address - Street 2:
Practice Address - City:CARLYLE
Practice Address - State:IL
Practice Address - Zip Code:62231-6407
Practice Address - Country:US
Practice Address - Phone:618-594-3671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601004526363A00000X
IL085003220363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL4903003Medicare PIN
MIN94880004Medicare ID - Type Unspecified