Provider Demographics
NPI:1487646840
Name:GULLA, CAROL (NP)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:GULLA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:CEDAR RUN
Mailing Address - State:NJ
Mailing Address - Zip Code:08092-2837
Mailing Address - Country:US
Mailing Address - Phone:609-978-1597
Mailing Address - Fax:
Practice Address - Street 1:640 WHITE HORSE PIKE
Practice Address - Street 2:
Practice Address - City:HAMMONTON
Practice Address - State:NJ
Practice Address - Zip Code:08037-9602
Practice Address - Country:US
Practice Address - Phone:609-567-9003
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN09719400363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJPO5226Medicare UPIN