Provider Demographics
NPI:1730795295
Name:KUKOROLA, DANA LYNN
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:LYNN
Last Name:KUKOROLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 CASTLEGLEN DR APT 106
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-5856
Mailing Address - Country:US
Mailing Address - Phone:214-642-2863
Mailing Address - Fax:
Practice Address - Street 1:806 CASTLEGLEN DR APT 106
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-5856
Practice Address - Country:US
Practice Address - Phone:214-642-2863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-21
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX343847164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse