Provider Demographics
NPI:1861076838
Name:ZULLO, KATIELEA KATHERINE (LPN)
Entity type:Individual
Prefix:MS
First Name:KATIELEA
Middle Name:KATHERINE
Last Name:ZULLO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 WOLCOTT RD
Mailing Address - Street 2:
Mailing Address - City:TERRYVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06786-6932
Mailing Address - Country:US
Mailing Address - Phone:203-206-5774
Mailing Address - Fax:
Practice Address - Street 1:141 WOLCOTT RD
Practice Address - Street 2:
Practice Address - City:TERRYVILLE
Practice Address - State:CT
Practice Address - Zip Code:06786-6932
Practice Address - Country:US
Practice Address - Phone:203-206-5774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-06
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT42953164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse