Provider Demographics
NPI:1215357454
Name:CULLAGH, IRENE P (RN IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:IRENE
Middle Name:P
Last Name:CULLAGH
Suffix:
Gender:F
Credentials:RN IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 MERRIMAN LN
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-2087
Mailing Address - Country:US
Mailing Address - Phone:203-980-5086
Mailing Address - Fax:
Practice Address - Street 1:25 MERRIMAN LN
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-2087
Practice Address - Country:US
Practice Address - Phone:203-980-5086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-25
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTE56291163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant