Healthcare Provider Details

I. General information

NPI: 1962162131
Provider Name (Legal Business Name): NATHALIE MARIE DULL FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2021
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 KANAKANAK ROAD SUITE 130
DILLINGHAM AK
99576
US

IV. Provider business mailing address

6000 KANAKANAK ROAD SUITE 130
DILLINGHAM AK
99576
US

V. Phone/Fax

Practice location:
  • Phone: 907-843-1044
  • Fax:
Mailing address:
  • Phone: 190-784-2520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number251133
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: