Provider Demographics
NPI:1942774930
Name:PULLEY, JAHMIRA
Entity Type:Individual
Prefix:
First Name:JAHMIRA
Middle Name:
Last Name:PULLEY
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 1:5805 CHRISTIAN ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19143-3001
Mailing Address - Country:US
Mailing Address - Phone:215-760-9983
Mailing Address - Fax:215-388-1806
Practice Address - Street 1:5805 CHRISTIAN ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19143-3001
Practice Address - Country:US
Practice Address - Phone:215-760-9983
Practice Address - Fax:215-388-1806
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-14
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN309286164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse