Provider Demographics
NPI:1558381129
Name:PULLEN, RUSSELL DEAN (PA)
Entity type:Individual
Prefix:
First Name:RUSSELL
Middle Name:DEAN
Last Name:PULLEN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10001 W INNOVATION DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4851
Mailing Address - Country:US
Mailing Address - Phone:888-938-3838
Mailing Address - Fax:888-919-1083
Practice Address - Street 1:341 WALLACE RD STE D
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-8001
Practice Address - Country:US
Practice Address - Phone:615-832-2200
Practice Address - Fax:615-832-2020
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2025-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5615363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN295910VVMedicare PIN
S74340Medicare UPIN