1699737189 NPI number — MRS. CAROL BURNHAM TULLER APRN

Table of content: MRS. CAROL BURNHAM TULLER APRN (NPI 1699737189)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699737189 NPI number — MRS. CAROL BURNHAM TULLER APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TULLER
Provider First Name:
CAROL
Provider Middle Name:
BURNHAM
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699737189
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/04/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21 WATERVILLE RD
Provider Second Line Business Mailing Address:
HARVEST HEALTHCARE C/O APPLE REHAB
Provider Business Mailing Address City Name:
AVON
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-678-9755
Provider Business Mailing Address Fax Number:
860-284-6804

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21 WATERVILLE RD
Provider Second Line Business Practice Location Address:
HARVEST HEALTHCARE C/O APPLE REHAB
Provider Business Practice Location Address City Name:
AVON
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-678-9755
Provider Business Practice Location Address Fax Number:
860-284-6804
Provider Enumeration Date:
04/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  CT000946 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LF0000X , with the licence number: 000946 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1699737189 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




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