Provider Demographics
NPI:1679349815
Name:PULLINS, AMANDA RANEE
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:RANEE
Last Name:PULLINS
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 1:540 BOYCE ST
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:OH
Mailing Address - Zip Code:43078-1410
Mailing Address - Country:US
Mailing Address - Phone:937-657-7453
Mailing Address - Fax:
Practice Address - Street 1:516 DOROTHY MOORE AVE
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:OH
Practice Address - Zip Code:43078-7414
Practice Address - Country:US
Practice Address - Phone:937-657-7453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide