Provider Demographics
NPI:1134760465
Name:KULIG, GABRIELLE MARIE (CRNP)
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:MARIE
Last Name:KULIG
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:GABRIELLE
Other - Middle Name:MARIE
Other - Last Name:LATORRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2005 TECHNOLOGY PKWY STE 440
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050-9413
Mailing Address - Country:US
Mailing Address - Phone:717-791-2540
Mailing Address - Fax:717-791-2549
Practice Address - Street 1:2005 TECHNOLOGY PKWY STE 440
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-9413
Practice Address - Country:US
Practice Address - Phone:717-791-2540
Practice Address - Fax:717-791-2549
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-08
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP021040363L00000X
PARN687150163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1037498750001Medicaid
PA1B5359OtherMEDICARE