Provider Demographics
NPI:1023455565
Name:SUBAH- SALEE, KULUBO K (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MRS
First Name:KULUBO
Middle Name:K
Last Name:SUBAH- SALEE
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:500 POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:SHARON HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19079-1327
Mailing Address - Country:US
Mailing Address - Phone:267-634-6410
Mailing Address - Fax:267-634-6439
Practice Address - Street 1:3801 MARKET ST
Practice Address - Street 2:SUITE 204
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-3153
Practice Address - Country:US
Practice Address - Phone:267-634-6410
Practice Address - Fax:267-634-6439
Is Sole Proprietor?:No
Enumeration Date:2013-05-23
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PARN537937163W00000X, 163WH0200X
PASP028807363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No163WH0200XNursing Service ProvidersRegistered NurseHome Health