Provider Demographics
NPI:1134364367
Name:KULAGA, BRANDY E (ACNP)
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:E
Last Name:KULAGA
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:BRANDY
Other - Middle Name:A
Other - Last Name:EMERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:190 RIVERSIDE ST
Mailing Address - Street 2:SUITE 6B
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-1073
Mailing Address - Country:US
Mailing Address - Phone:207-661-2000
Mailing Address - Fax:
Practice Address - Street 1:22 BRAMHALL ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-3134
Practice Address - Country:US
Practice Address - Phone:207-662-5610
Practice Address - Fax:207-662-3790
Is Sole Proprietor?:No
Enumeration Date:2008-12-02
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP81936363LA2100X
MER055533363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEE400370408Medicare PIN
MEE400370396Medicare PIN