Healthcare Provider Details

I. General information

NPI: 1003751892
Provider Name (Legal Business Name): JOHN MICHAEL ULYSSES DULKO RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19125 N CREEK PKWY STE 120
BOTHELL WA
98011-8000
US

IV. Provider business mailing address

PSC 201 BOX 1108
FPO AA
34010-0012
US

V. Phone/Fax

Practice location:
  • Phone: 971-203-2114
  • Fax:
Mailing address:
  • Phone: 516-578-8920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberR263089
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: