Provider Demographics
NPI:1164521712
Name:PULDA, KATHY VOLIN (MS, APRN, GNP, BC)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:VOLIN
Last Name:PULDA
Suffix:
Gender:F
Credentials:MS, APRN, GNP, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2153 DEPT 40338
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35287-9386
Mailing Address - Country:US
Mailing Address - Phone:706-271-0100
Mailing Address - Fax:
Practice Address - Street 1:378 PLANTATION ST
Practice Address - Street 2:GERIATRICS DEPARTMENT
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-2324
Practice Address - Country:US
Practice Address - Phone:508-755-7300
Practice Address - Fax:508-755-7395
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA143746363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110090643AMedicaid
MA110090643AMedicaid
MANP564101Medicare PIN