Provider Demographics
NPI:1184015661
Name:CULLAM, JOANN (RN)
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:
Last Name:CULLAM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3128 WILSHIRE LN
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11769-1441
Mailing Address - Country:US
Mailing Address - Phone:631-337-1732
Mailing Address - Fax:
Practice Address - Street 1:3128 WILSHIRE LN
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:NY
Practice Address - Zip Code:11769-1441
Practice Address - Country:US
Practice Address - Phone:631-337-1732
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-05
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY690262163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse