# MARY KATHLEEN DITULLIO

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1053304998
- **Gender:** F
- **Credential:** CRNP

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | VP003581G | PA | Yes |

## Other

- **Enumeration date:** 08/25/2005
- **Last updated:** 04/16/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1565773 | GATEWAY | PA |
| 01 | — | 1988988 | BLUE SHIELD | PA |
| 01 | — | P00406374 | RR MEDICARE | PA |