Provider Demographics
NPI:1235597352
Name:CULP, EDNA
Entity Type:Individual
Prefix:
First Name:EDNA
Middle Name:
Last Name:CULP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:EDNA
Other - Middle Name:VILLALUNA
Other - Last Name:CULP
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CNS
Mailing Address - Street 1:14562 HIGH PINE ST
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-5918
Mailing Address - Country:US
Mailing Address - Phone:858-922-3504
Mailing Address - Fax:
Practice Address - Street 1:14562 HIGH PINE ST
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-5918
Practice Address - Country:US
Practice Address - Phone:858-668-1750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-03
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4361364SG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SG0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4361OtherBRN