Provider Demographics
NPI:1972796266
Name:CULEN, CHERYL HENRIETTA (MSN, FNP, PMHNP)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:HENRIETTA
Last Name:CULEN
Suffix:
Gender:F
Credentials:MSN, FNP, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 W UNION ST
Mailing Address - Street 2:
Mailing Address - City:BENSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85602-6718
Mailing Address - Country:US
Mailing Address - Phone:520-586-0800
Mailing Address - Fax:520-586-6103
Practice Address - Street 1:611 W UNION ST
Practice Address - Street 2:
Practice Address - City:BENSON
Practice Address - State:AZ
Practice Address - Zip Code:85602-6718
Practice Address - Country:US
Practice Address - Phone:520-586-0800
Practice Address - Fax:520-586-6103
Is Sole Proprietor?:No
Enumeration Date:2007-08-21
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-006153363LF0000X, 363LP0808X
AZAP4698363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL1041Medicare PIN
ILK49262Medicare PIN
ILK49261Medicare PIN