Organization
GREATER SCRANTON YMCA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KATHRYN LOUISE TULLIO MS,RDN,LDN (REGISTERED DIETITIAN)
(570) 342-8115
Entity
Organization
Contact information
Practice address
706 N BLAKELY ST, DUNMORE, PA 18512-1937
(570) 342-8115
Mailing address
706 N BLAKELY ST, DUNMORE, PA 18512-1937
(570) 342-8115
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
DN00270
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5231946
AETNA
PA
Enumeration date
01/03/2014
Last updated
01/03/2014
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