Individual
DONNA L TULLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1179 N MCDOWELL BLVD, PETALUMA, CA 94954-6559
(707) 559-7500
(707) 559-7570
Mailing address
1179 N MCDOWELL BLVD, PETALUMA, CA 94954-6559
(707) 559-7500
(707) 559-7570
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2003-0035
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
25486080
—
NM
Enumeration date
11/07/2005
Last updated
03/01/2014
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