Provider Demographics
NPI:1235792177
Name:PULLEN, ALEXA BREANNE (RD)
Entity type:Individual
Prefix:
First Name:ALEXA
Middle Name:BREANNE
Last Name:PULLEN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12110 BUSINESS BLVD STE 6
Mailing Address - Street 2:PMB 189
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-7798
Mailing Address - Country:US
Mailing Address - Phone:907-854-4482
Mailing Address - Fax:
Practice Address - Street 1:19239 DARBY RD
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577
Practice Address - Country:US
Practice Address - Phone:907-854-4482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-16
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK145169133N00000X
TXDT86980133V00000X
AK229812133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist