Individual
MRS. LORRAINE T KULESA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
320 WESTERN BLVD, SUITE 102, GLASTONBURY, CT 06033
(860) 633-9235
(860) 657-2781
Mailing address
12 GRASS BONNET LANE, WETHERSFIELD, CT 06109
(860) 529-3707
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
000051
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00417456200
—
CT
01
—
400APRNSICT01
BCBS ANTHEM
—
Enumeration date
02/02/2007
Last updated
08/10/2011
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