Healthcare Provider Details

I. General information

NPI: 1134760465
Provider Name (Legal Business Name): GABRIELLE MARIE KULIG CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: GABRIELLE MARIE LATORRE

II. Dates (important events)

Enumeration Date: 10/08/2019
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 WALNUT ST STE 100
LEMOYNE PA
17043-1168
US

IV. Provider business mailing address

2005 TECHNOLOGY PKWY STE 440
MECHANICSBURG PA
17050-9413
US

V. Phone/Fax

Practice location:
  • Phone: 717-791-2549
  • Fax: 717-791-2549
Mailing address:
  • Phone: 717-791-2540
  • Fax: 717-791-2549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN687150
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP021040
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: