Individual
KRISTIN HEATHER GULLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PNP
Contact information
Practice address
225 COMMUNITY DR, GREAT NECK, NY 11021-5503
(516) 829-9409
(516) 829-2713
Mailing address
16 LIDO PKWY, LINDENHURST, NY 11757-6017
(516) 817-8011
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
383084
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
383084
NYS PEDIATRIC NURSE PRACTITIONER LICENSE
NY
Enumeration date
10/13/2020
Last updated
10/13/2020
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