Individual
KAITLYN RULLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
55 BROADWAY, BANGOR, ME 04401-5201
(207) 947-0469
(207) 947-5368
Mailing address
489 STATE ST, BANGOR, ME 04401-6616
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
PA2440
ME
363A00000X
Physician Assistant
—
—
Other
Enumeration date
06/13/2022
Last updated
09/21/2023
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