Provider Demographics
NPI:1497351647
Name:CULLUM, BILLIE DANA
Entity Type:Individual
Prefix:
First Name:BILLIE
Middle Name:DANA
Last Name:CULLUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7733 NW 29TH ST
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:OK
Mailing Address - Zip Code:73008-4437
Mailing Address - Country:US
Mailing Address - Phone:405-506-0816
Mailing Address - Fax:
Practice Address - Street 1:7733 NW 29TH ST
Practice Address - Street 2:
Practice Address - City:BETHANY
Practice Address - State:OK
Practice Address - Zip Code:73008-4437
Practice Address - Country:US
Practice Address - Phone:405-506-0816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker