Provider Demographics
NPI:1801565924
Name:DULLUM, JUDIE ANN (RN)
Entity type:Individual
Prefix:MRS
First Name:JUDIE
Middle Name:ANN
Last Name:DULLUM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N4209 COUNTY RD E
Mailing Address - Street 2:
Mailing Address - City:BRODHEAD
Mailing Address - State:WI
Mailing Address - Zip Code:53520-9607
Mailing Address - Country:US
Mailing Address - Phone:608-897-6380
Mailing Address - Fax:
Practice Address - Street 1:N4209 COUNTY RD E
Practice Address - Street 2:
Practice Address - City:BRODHEAD
Practice Address - State:WI
Practice Address - Zip Code:53520-9607
Practice Address - Country:US
Practice Address - Phone:608-897-6380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-10
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI154736163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse