Provider Demographics
NPI:1710742499
Name:CULOTTA, CHERYL JACQUELINE (CPNP)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:JACQUELINE
Last Name:CULOTTA
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6560 TWILIGHT GLOW DR
Mailing Address - Street 2:
Mailing Address - City:ELDERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21784-8016
Mailing Address - Country:US
Mailing Address - Phone:443-609-4258
Mailing Address - Fax:
Practice Address - Street 1:4985 ILCHESTER RD
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-6837
Practice Address - Country:US
Practice Address - Phone:410-733-5179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR082366363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics