Individual
DR. NATHAN ALLEN ULLOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
1400 E KINCAID ST, MOUNT VERNON, WA 98274-4127
(360) 848-4120
(360) 424-7945
Mailing address
1400 E KINCAID ST, ATTN: CREDENTIALING, MOUNT VERNON, WA 98274-4127
(360) 428-2500
(360) 428-6485
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
PO60398534
WA
213ES0103X
Foot & Ankle Surgery Podiatrist
PO60398534
WA
213ES0103X
Foot & Ankle Surgery Podiatrist
SC006241
PA
Other
Enumeration date
08/09/2010
Last updated
09/17/2013
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