| Doctor Name: | EVA LOIS ULLOM |
| NPI Number: | 1275829566 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RN, FNP-C |
| License Number: | AP06502 |
| Business Practice Address: | 325 W 8th St Deridder, LA - 706345505 |
| Business Phone Number: | 3374633387 |
| Business Fax Number: | 9498625301 |
| Mailing Address: | 2186 Ball Rd, DERIDDER |
| State: | LA |
| Postal Code: | 706346656 |
| Phone Number: | 3374633766 |
| Fax Number: | 3374633766 |
| NPI Enumeration Date: | 06/24/2011 |
| NPI Last Update Date: | 06/24/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | AP06502 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | LA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |