Provider Demographics
NPI:1891956777
Name:CULLEN, NICOLE R (MD)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:R
Last Name:CULLEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13808 PROFESSIONAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-7948
Mailing Address - Country:US
Mailing Address - Phone:704-377-4009
Mailing Address - Fax:919-843-9355
Practice Address - Street 1:13808 PROFESSIONAL CENTER DR
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-7948
Practice Address - Country:US
Practice Address - Phone:704-377-4009
Practice Address - Fax:919-843-9355
Is Sole Proprietor?:No
Enumeration Date:2008-06-23
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC148721390200000X
NC2014-01077207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program