Provider Demographics
NPI:1679930622
Name:PULJIC, RACHAEL ELIZABETH
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:ELIZABETH
Last Name:PULJIC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RACHAEL
Other - Middle Name:ELIZABETH
Other - Last Name:STERN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1055 OLD RIVER RD APT 835
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44113-5824
Mailing Address - Country:US
Mailing Address - Phone:814-591-5893
Mailing Address - Fax:
Practice Address - Street 1:315 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44114-2206
Practice Address - Country:US
Practice Address - Phone:814-591-5893
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-21
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.026050363LF0000X
PASP015754363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily