Individual
SHANNON P KUKULKA
Active
Individual
SHANNON P KUKULKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
6878
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1982072591
UNITED HEALTHCARE
CT
05
—
1982072591
—
CT
01
—
4869372
AETNA
CT
01
—
6028631
CIGNA
CT
01
—
AA533003
HARVARD PILGRIM
CT
01
—
P5602305
OXFORD
CT
Enumeration date
09/14/2015
Last updated
01/03/2018
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