Provider Demographics
NPI:1528587474
Name:KULACZ, DEANNA M (MSN, RN-BC, AGNP-C)
Entity Type:Individual
Prefix:MS
First Name:DEANNA
Middle Name:M
Last Name:KULACZ
Suffix:
Gender:F
Credentials:MSN, RN-BC, AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 STONEWALL CIR
Mailing Address - Street 2:
Mailing Address - City:WEST HARRISON
Mailing Address - State:NY
Mailing Address - Zip Code:10604-1144
Mailing Address - Country:US
Mailing Address - Phone:917-499-3099
Mailing Address - Fax:
Practice Address - Street 1:61 GRASSLANDS RD
Practice Address - Street 2:
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595-1543
Practice Address - Country:US
Practice Address - Phone:917-499-3099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-12
Last Update Date:2022-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF308365363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health