Provider Demographics
NPI:1679838387
Name:CULLEN, STEPHEN (PA-C)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:CULLEN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 WAKE ROBIN RD
Mailing Address - Street 2:UNIT 5
Mailing Address - City:LINCOLN
Mailing Address - State:RI
Mailing Address - Zip Code:02865-4294
Mailing Address - Country:US
Mailing Address - Phone:401-475-7308
Mailing Address - Fax:401-475-2808
Practice Address - Street 1:3 WAKE ROBIN RD
Practice Address - Street 2:UNIT 5
Practice Address - City:LINCOLN
Practice Address - State:RI
Practice Address - Zip Code:02865-4294
Practice Address - Country:US
Practice Address - Phone:401-475-7308
Practice Address - Fax:401-475-2808
Is Sole Proprietor?:No
Enumeration Date:2012-07-09
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPA00640363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant