Provider Demographics
NPI:1972551489
Name:CULLION, DIAN JOAN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:DIAN
Middle Name:JOAN
Last Name:CULLION
Suffix:
Gender:F
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 1:881 GREENWICH AVE UNIT 30
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-1870
Mailing Address - Country:US
Mailing Address - Phone:401-295-5982
Mailing Address - Fax:
Practice Address - Street 1:1524 ATWOOD AVE STE 322
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:RI
Practice Address - Zip Code:02919-3228
Practice Address - Country:US
Practice Address - Phone:508-340-1579
Practice Address - Fax:774-565-0469
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2020-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPA00100363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI2501291OtherUNITED HEALTH
RI9004005Medicaid
RI412907OtherBLUE CHIP
RI29928OtherBLUE CROSS
RIS70568Medicare UPIN
979005979Medicare PIN