Provider Demographics
NPI:1568246882
Name:KULICH, MAEGAN ALAURA (RN)
Entity Type:Individual
Prefix:
First Name:MAEGAN
Middle Name:ALAURA
Last Name:KULICH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7087 HIGHWAY 151
Mailing Address - Street 2:
Mailing Address - City:AVA
Mailing Address - State:IL
Mailing Address - Zip Code:62907-2447
Mailing Address - Country:US
Mailing Address - Phone:161-823-1027
Mailing Address - Fax:
Practice Address - Street 1:405 W JACKSON ST
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-1462
Practice Address - Country:US
Practice Address - Phone:618-549-0721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041508289163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse