Individual
KARA LEAH DITULLIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA C
Contact information
Practice address
4674 SNOW MESA DR, SUITE140, FORT COLLINS, CO 80528-8615
(970) 482-0213
Mailing address
4674 SNOW MESA DR, SUITE140, FORT COLLINS, CO 80528-8615
(970) 482-0213
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
345
STATE LICENSE
WY
01
—
419KLD0514
SUBSTANCE CONTROL
WY
Enumeration date
11/23/2005
Last updated
10/16/2007
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