Provider Demographics
NPI:1265171920
Name:TULKE, ANNA ELIZABETH
Entity type:Individual
Prefix:MISS
First Name:ANNA
Middle Name:ELIZABETH
Last Name:TULKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 HYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50014-7446
Mailing Address - Country:US
Mailing Address - Phone:814-451-4654
Mailing Address - Fax:
Practice Address - Street 1:534 WALLACE RD
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50011-4008
Practice Address - Country:US
Practice Address - Phone:515-294-8009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILT420-045016362255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer