Provider Demographics
NPI:1508000803
Name:KULLAK, JAIME DAUNT (RN,WHNP)
Entity Type:Individual
Prefix:MISS
First Name:JAIME
Middle Name:DAUNT
Last Name:KULLAK
Suffix:
Gender:F
Credentials:RN,WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 CONGRESS ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-0907
Mailing Address - Country:US
Mailing Address - Phone:617-479-6636
Mailing Address - Fax:
Practice Address - Street 1:300 CONGRESS ST
Practice Address - Street 2:102
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-0907
Practice Address - Country:US
Practice Address - Phone:617-479-6636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-30
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN265781363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology