Provider Demographics
NPI:1851358212
Name:CULLEN-DRILL, MARY MARGARET (RN, APN, C)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:MARGARET
Last Name:CULLEN-DRILL
Suffix:
Gender:F
Credentials:RN, APN, C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 EDGEMONT RD
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-2305
Mailing Address - Country:US
Mailing Address - Phone:973-744-5133
Mailing Address - Fax:973-744-7163
Practice Address - Street 1:51 UPPER MONTCLAIR PLZ
Practice Address - Street 2:SUITE 21
Practice Address - City:UPPER MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07043-1343
Practice Address - Country:US
Practice Address - Phone:973-477-8628
Practice Address - Fax:973-744-7163
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NC07979500364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6807909Medicaid
NJ023230SBPMedicare ID - Type UnspecifiedMEDICARE #