Provider Demographics
NPI:1346510120
Name:KULPA, LAURALYN PUCCIO (RN)
Entity Type:Individual
Prefix:
First Name:LAURALYN
Middle Name:PUCCIO
Last Name:KULPA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1517 VAN HOESEN RD
Mailing Address - Street 2:
Mailing Address - City:CASTLETON
Mailing Address - State:NY
Mailing Address - Zip Code:12033-9694
Mailing Address - Country:US
Mailing Address - Phone:518-732-0836
Mailing Address - Fax:
Practice Address - Street 1:19 WARDS LN
Practice Address - Street 2:
Practice Address - City:MENANDS
Practice Address - State:NY
Practice Address - Zip Code:12204-2172
Practice Address - Country:US
Practice Address - Phone:518-465-4561
Practice Address - Fax:518-434-2840
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-10
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY490909163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool