Provider Demographics
NPI:1386667558
Name:DULA, GARY A (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:A
Last Name:DULA
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:JAMES H. QUILLEN VETERAN'S ADMINISTRATION MEDICAL CTR.
Mailing Address - Street 2:NURSING HOME CARE UNIT
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:TN
Mailing Address - Zip Code:37684
Mailing Address - Country:US
Mailing Address - Phone:423-979-2836
Mailing Address - Fax:423-979-2829
Practice Address - Street 1:JAMES H. QUILLEN VETERAN'S ADMINISTRATION MEDICAL CTR.
Practice Address - Street 2:NURSING HOME CARE UNIT
Practice Address - City:MOUNTAIN HOME
Practice Address - State:TN
Practice Address - Zip Code:37684
Practice Address - Country:US
Practice Address - Phone:423-979-2836
Practice Address - Fax:423-979-2829
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000006845363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner