Provider Demographics
NPI:1265417950
Name:DULA, MICHELE A (CNP)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:A
Last Name:DULA
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:A
Other - Last Name:KLOOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:20050 HARVARD AVE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:WARRENSVILLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-6816
Mailing Address - Country:US
Mailing Address - Phone:216-475-0440
Mailing Address - Fax:
Practice Address - Street 1:20050 HARVARD AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:WARRENSVILLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44122-6816
Practice Address - Country:US
Practice Address - Phone:216-475-0440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2007-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP-03295363L00000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000495738OtherANTHEM
OH000000363818OtherANTHEM
OH2108945Medicaid
OHNP77891OtherMEDICARE PIN
OHP00331716OtherMEDICARE PIN
OHNP77891OtherMEDICARE PIN
OH2108945Medicaid