Provider Demographics
NPI:1336893882
Name:DULSKI, KAITLYN CONWAY (NP)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:CONWAY
Last Name:DULSKI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 HUNTINGTON WAY
Mailing Address - Street 2:
Mailing Address - City:BALLSTON SPA
Mailing Address - State:NY
Mailing Address - Zip Code:12020-2944
Mailing Address - Country:US
Mailing Address - Phone:518-588-0854
Mailing Address - Fax:
Practice Address - Street 1:46 E MAIN ST
Practice Address - Street 2:
Practice Address - City:FONDA
Practice Address - State:NY
Practice Address - Zip Code:12068-4821
Practice Address - Country:US
Practice Address - Phone:518-853-3190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-03
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY349133363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily