Provider Demographics
NPI:1659857464
Name:CULLEN, LUANN FRANCES (NMD)
Entity Type:Individual
Prefix:DR
First Name:LUANN
Middle Name:FRANCES
Last Name:CULLEN
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 CORNELL CIR
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81005-1613
Mailing Address - Country:US
Mailing Address - Phone:480-455-9851
Mailing Address - Fax:
Practice Address - Street 1:3394 W MEGAN ST
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-2356
Practice Address - Country:US
Practice Address - Phone:480-455-9851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-15
Last Update Date:2018-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COND.0000165175F00000X
AZ18-1756175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath