Provider Demographics
NPI:1376196840
Name:CULLEN, EMILY LOUISE (FNP)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:LOUISE
Last Name:CULLEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1235 MEADOWVIEW LN
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:OH
Mailing Address - Zip Code:44001-1032
Mailing Address - Country:US
Mailing Address - Phone:419-654-0571
Mailing Address - Fax:
Practice Address - Street 1:3800 BOARDWALK BLVD
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-7033
Practice Address - Country:US
Practice Address - Phone:419-621-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-23
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.024767363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily