Individual
MARY KATHLEEN DITULLIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
17 MERLINE AVE, ERIE, PA 16509-1567
(814) 868-9484
(814) 866-5904
Mailing address
17 MERLINE AVE, ERIE, PA 16509-1567
(814) 868-9484
(814) 866-5904
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
VP003581G
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1565773
GATEWAY
PA
01
—
1988988
BLUE SHIELD
PA
01
—
P00406374
RR MEDICARE
PA
Enumeration date
08/25/2005
Last updated
04/16/2013
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