Provider Demographics
NPI:1790841161
Name:CULLINAN, NINA RAE (ARNP RNC)
Entity Type:Individual
Prefix:MRS
First Name:NINA
Middle Name:RAE
Last Name:CULLINAN
Suffix:
Gender:F
Credentials:ARNP RNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:727 N WEST ST
Mailing Address - Street 2:
Mailing Address - City:CARROLL
Mailing Address - State:IA
Mailing Address - Zip Code:51401-2348
Mailing Address - Country:US
Mailing Address - Phone:712-792-4020
Mailing Address - Fax:
Practice Address - Street 1:727 N WEST ST
Practice Address - Street 2:
Practice Address - City:CARROLL
Practice Address - State:IA
Practice Address - Zip Code:51401-2348
Practice Address - Country:US
Practice Address - Phone:712-792-4020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAF071525363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI0401Medicare ID - Type Unspecified