Provider Demographics
NPI:1629477971
Name:CULLIGAN, JODI MARIE (LVN)
Entity Type:Individual
Prefix:MISS
First Name:JODI
Middle Name:MARIE
Last Name:CULLIGAN
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1539 TAVERN RD APT 123
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:CA
Mailing Address - Zip Code:91901-3841
Mailing Address - Country:US
Mailing Address - Phone:858-603-2492
Mailing Address - Fax:
Practice Address - Street 1:1539 TAVERN RD APT 123
Practice Address - Street 2:
Practice Address - City:ALPINE
Practice Address - State:CA
Practice Address - Zip Code:91901-3841
Practice Address - Country:US
Practice Address - Phone:858-603-2492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-21
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA258922164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse