Provider Demographics
NPI:1235277252
Name:KULESA, LORRAINE T (APRN)
Entity Type:Individual
Prefix:MRS
First Name:LORRAINE
Middle Name:T
Last Name:KULESA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:LORRAINE
Other - Middle Name:
Other - Last Name:TESTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12 GRASS BONNET LANE
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109
Mailing Address - Country:US
Mailing Address - Phone:860-529-3707
Mailing Address - Fax:
Practice Address - Street 1:320 WESTERN BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033
Practice Address - Country:US
Practice Address - Phone:860-633-9235
Practice Address - Fax:860-657-2781
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000051363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT00417456200Medicaid
400APRNSICT01OtherBCBS ANTHEM
S68301Medicare UPIN