Provider Demographics
NPI:1841759065
Name:KULESH, JOANNE BOCCUZZI (CRNP-FAMILY)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:BOCCUZZI
Last Name:KULESH
Suffix:
Gender:F
Credentials:CRNP-FAMILY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18513 TRAXELL WAY
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20879-1797
Mailing Address - Country:US
Mailing Address - Phone:240-793-4420
Mailing Address - Fax:
Practice Address - Street 1:18513 TRAXELL WAY
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879-1797
Practice Address - Country:US
Practice Address - Phone:240-793-4420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-18
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR081309363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily