Provider Demographics
NPI:1013242502
Name:KAWULOK, DEBRA A (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:A
Last Name:KAWULOK
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MS
Other - First Name:DEBRA
Other - Middle Name:ANN
Other - Last Name:RADDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:304 COFFEEN AVE
Mailing Address - Street 2:STE A
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-4803
Mailing Address - Country:US
Mailing Address - Phone:307-674-1744
Mailing Address - Fax:307-674-1752
Practice Address - Street 1:304 COFFEEN AVE
Practice Address - Street 2:STE A
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-4803
Practice Address - Country:US
Practice Address - Phone:307-674-1744
Practice Address - Fax:307-674-1752
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-16
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY11988.1019363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
W23011Medicare PIN