Provider Demographics
NPI:1770284242
Name:PULKSTENIS, SUELLEN C
Entity type:Individual
Prefix:
First Name:SUELLEN
Middle Name:C
Last Name:PULKSTENIS
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 1:35 MEADOW RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:NJ
Mailing Address - Zip Code:07848-2628
Mailing Address - Country:US
Mailing Address - Phone:862-266-4874
Mailing Address - Fax:
Practice Address - Street 1:35 MEADOW RIDGE LN
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:NJ
Practice Address - Zip Code:07848-2628
Practice Address - Country:US
Practice Address - Phone:862-266-4874
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-13
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00883000363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care