Provider Demographics
NPI:1376857094
Name:ULLMAN, ALAN J (NP)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:J
Last Name:ULLMAN
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 CONOVER DR STE B
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:OH
Mailing Address - Zip Code:45005-1900
Mailing Address - Country:US
Mailing Address - Phone:513-318-1188
Mailing Address - Fax:513-318-1189
Practice Address - Street 1:333 CONOVER DR STE B
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:OH
Practice Address - Zip Code:45005-1900
Practice Address - Country:US
Practice Address - Phone:513-318-1188
Practice Address - Fax:513-318-1189
Is Sole Proprietor?:No
Enumeration Date:2010-08-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP 11601363LF0000X
OHCOA-11601-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHNP 11601OtherOHIO NP LICENSE
OH3107140Medicaid
OHMU2274354OtherDEA