Individual
MISS NICOLE DIANN LULLMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1409 CLARK ST, DES MOINES, IA 50314-1964
(515) 643-6554
(515) 643-6555
Mailing address
1409 CLARK ST, DES MOINES, IA 50314-1964
(515) 643-6554
(515) 643-6555
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
08116
IA
Other
Enumeration date
08/02/2011
Last updated
08/02/2011
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