Provider Demographics
NPI:1508021635
Name:KULUNGOWSKI, KATHRYN A
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:A
Last Name:KULUNGOWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:KATHRYN
Other - Middle Name:A
Other - Last Name:BURG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:215 N MAGNOLIA ST
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-4943
Mailing Address - Country:US
Mailing Address - Phone:803-775-9364
Mailing Address - Fax:803-773-6615
Practice Address - Street 1:215 N MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-4943
Practice Address - Country:US
Practice Address - Phone:803-775-9364
Practice Address - Fax:803-773-6615
Is Sole Proprietor?:No
Enumeration Date:2008-07-29
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCR201039163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse