Provider Demographics
NPI:1013096460
Name:CULLITON, LISA GAIL (APRN, BSN, MSN)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:GAIL
Last Name:CULLITON
Suffix:
Gender:
Credentials:APRN, BSN, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 720686
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73070-4522
Mailing Address - Country:US
Mailing Address - Phone:405-857-7681
Mailing Address - Fax:
Practice Address - Street 1:1201 MAGNOLIA CT
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-1394
Practice Address - Country:US
Practice Address - Phone:405-857-7681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK209314363LP0200X
MO131255363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics