Basic Information
| Provider Information | |||||||||
| NPI: | 1386667558 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DULA | ||||||||
| FirstName: | GARY | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | NURSE PRACTITIONER | ||||||||
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| Mailing Information | |||||||||
| Address1: | JAMES H. QUILLEN VETERAN'S ADMINISTRATION MEDICAL CTR. | ||||||||
| Address2: | NURSING HOME CARE UNIT | ||||||||
| City: | MOUNTAIN HOME | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37684 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4239792836 | ||||||||
| FaxNumber: | 4239792829 | ||||||||
| Practice Location | |||||||||
| Address1: | JAMES H. QUILLEN VETERAN'S ADMINISTRATION MEDICAL CTR. | ||||||||
| Address2: | NURSING HOME CARE UNIT | ||||||||
| City: | MOUNTAIN HOME | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37684 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4239792836 | ||||||||
| FaxNumber: | 4239792829 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | APN0000006845 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.