Provider Demographics
NPI:1194802934
Name:GULOTTA, ROSSANEL NMI (CRNFA)
Entity type:Individual
Prefix:
First Name:ROSSANEL
Middle Name:NMI
Last Name:GULOTTA
Suffix:
Gender:F
Credentials:CRNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 NE PARVIN RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116-5003
Mailing Address - Country:US
Mailing Address - Phone:816-459-8767
Mailing Address - Fax:816-523-5747
Practice Address - Street 1:6400 PROSPECT AVE STE 546
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64132-4133
Practice Address - Country:US
Practice Address - Phone:816-523-7088
Practice Address - Fax:816-523-5747
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO041435163WR0006X
KS14-60063-092163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS163WR0006XMedicare UPIN
MO163WR0006XMedicare UPIN