Provider Demographics
NPI:1619148905
Name:WOLUCKA, DANA LYNN (BSN, MSN/FNP)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:LYNN
Last Name:WOLUCKA
Suffix:
Gender:F
Credentials:BSN, MSN/FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:COLUSA
Mailing Address - State:CA
Mailing Address - Zip Code:95932-2851
Mailing Address - Country:US
Mailing Address - Phone:530-458-2300
Mailing Address - Fax:530-458-5558
Practice Address - Street 1:717 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:COLUSA
Practice Address - State:CA
Practice Address - Zip Code:95932-2851
Practice Address - Country:US
Practice Address - Phone:530-458-2300
Practice Address - Fax:530-458-5558
Is Sole Proprietor?:No
Enumeration Date:2008-03-14
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17869363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner