MRS. GERALYN SUE PRULLAGE


Address: 2910 Gilbert Ln, Alton, IL 62002-5504
Phone: 6183632707

MRS. GERALYN SUE PRULLAGE (NPI# 1164723656) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1164723656
Entity Type Individual
Full Name MRS. GERALYN SUE PRULLAGE
Other Name GERALYN SUE PRULLAGE
Credential APN
Practice Address 2910 Gilbert Ln
Alton
IL 62002-5504
Practice Telephone 6183632707
Mailing Telephone 6183632707
Enumeration Date 2010-11-15
Last Update Date 2010-11-15
Gender Code F
Is Sole Proprietor Y

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 363LN0005X Nurse Practitioner
Specialization: Neonatal, Critical Care
041207587 IL Physician Assistants & Advanced Practice Nursing Providers

Office Location

Street Address 2910 GILBERT LN
City ALTON
State IL
Zip Code 62002-5504

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1841848322 Destiny L Miller Technician 3429 Meridocia St, Alton, IL 62002 2019-08-28
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1194380741 Vasiliki Kytridou Dentist 2800 College Avenue Southern Il University School of De, Building 285, Alton, IL 62002 2019-05-08
1982125910 Amy Nicole Spalding Social Worker 1123 Harrison St, Alton, IL 62002 2017-06-29
1962856310 Patricia Gregory Social Worker 5090 Humbert Rd, Alton, IL 62002 2016-04-21
1447612510 Alanna Lynn Mcnelly Chiropractor 219 Piasa St, Suite 200, Alton, IL 62002 2016-03-28
1174983050 Roberta's Lovely Ladies Boutique Mastectomy Fitter 603 W. Delmar, Alton, IL 62002 2016-03-04
1184081556 Darcy Graham Nurse Practitioner 4 Memorial Dr # 210, Alton, IL 62002 2016-01-15
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Taxonomy Information

Taxonomy Code 363LN0005X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Nurse Practitioner
Specialization Neonatal, Critical Care

Taxonomy Definition

Definition to come...

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NPI Name Taxonomy Address Enumeration
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1710510433 Helen Medina Nurse Practitioner 225 E Chicago Ave, Chicago, IL 60611-2991 2020-02-20
1164053484 Amber Sara Johnson Nurse Practitioner 5841 S Maryland Ave, Chicago, IL 60637-1443 2020-01-27
1013564962 Jodi Lynn Isley Nurse Practitioner 503 N Maple St, Effingham, IL 62401-2099 2019-08-23
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Competitor

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City ALTON
Zip Code 62002

Improve Information

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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