Provider Demographics
NPI:1427396068
Name:KULP, MAIJA CARRIE (APRN)
Entity Type:Individual
Prefix:
First Name:MAIJA
Middle Name:CARRIE
Last Name:KULP
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MAIJA
Other - Middle Name:CARRIE
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4704 HOEN AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-7824
Mailing Address - Country:US
Mailing Address - Phone:707-546-7979
Mailing Address - Fax:707-546-7667
Practice Address - Street 1:4704 HOEN AVE
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-7824
Practice Address - Country:US
Practice Address - Phone:707-546-7979
Practice Address - Fax:707-546-7667
Is Sole Proprietor?:No
Enumeration Date:2013-01-16
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209010270363LA2200X
KY3009369363LA2200X
CANP95005696363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health