Doctor Name: | MRS. DEBRA A KAWULOK |
NPI Number: | 1013242502 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP-C |
License Number: | 11988.1019 |
Business Practice Address: | 304 Coffeen Ave Ste A Sheridan, WY - 828014803 |
Business Phone Number: | 3076741744 |
Business Fax Number: | 3076741752 |
Mailing Address: | 304 Coffeen Ave, Ste A SHERIDAN |
State: | WY |
Postal Code: | 828014803 |
Phone Number: | 3076741744 |
Fax Number: | 3076741752 |
NPI Enumeration Date: | 10/16/2009 |
NPI Last Update Date: | 04/07/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 11988.1019 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WY |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |