Provider Demographics
NPI:1700077682
Name:KULALIC, ALMA (LPN AND RN)
Entity Type:Individual
Prefix:
First Name:ALMA
Middle Name:
Last Name:KULALIC
Suffix:
Gender:F
Credentials:LPN AND RN
Other - Prefix:
Other - First Name:ALMA
Other - Middle Name:
Other - Last Name:SAKIC
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:702 ALBANY ST
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-1851
Mailing Address - Country:US
Mailing Address - Phone:315-792-4894
Mailing Address - Fax:
Practice Address - Street 1:702 ALBANY ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-1851
Practice Address - Country:US
Practice Address - Phone:315-792-4894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY567943163W00000X
NY267125164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02461021Medicaid