Basic Information
Provider Information
NPI: 1487188793
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DULL
FirstName: KATRINA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: B.A.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2258 JUDY LN
Address2:  
City: COOPERSBURG
State: PA
PostalCode: 180363752
CountryCode: US
TelephoneNumber: 4845477165
FaxNumber:  
Practice Location
Address1: 807 LAWN AVE
Address2:  
City: SELLERSVILLE
State: PA
PostalCode: 189601549
CountryCode: US
TelephoneNumber: 2152576551
FaxNumber: 2152579347
Other Information
ProviderEnumerationDate: 04/13/2017
LastUpdateDate: 04/13/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
106S00000X  Y    

No ID Information.


Home