Provider Demographics
NPI:1710420302
Name:KULESZA, EMILIE
Entity Type:Individual
Prefix:
First Name:EMILIE
Middle Name:
Last Name:KULESZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DH PHYSICIANS PO BOX 829641
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-9641
Mailing Address - Country:US
Mailing Address - Phone:267-370-5296
Mailing Address - Fax:215-230-3725
Practice Address - Street 1:4897 YORK ROAD
Practice Address - Street 2:BUCKINGHAM FAMILY MEDICINE
Practice Address - City:BUCKINGHAM
Practice Address - State:PA
Practice Address - Zip Code:18912
Practice Address - Country:US
Practice Address - Phone:215-794-7471
Practice Address - Fax:215-794-2576
Is Sole Proprietor?:No
Enumeration Date:2016-11-30
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP016891363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASP016891OtherCRNP LICENSE