Provider Demographics
NPI:1013972892
Name:CULLISON, MICHELLE SUSAN (CNM, MSN)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:SUSAN
Last Name:CULLISON
Suffix:
Gender:F
Credentials:CNM, MSN
Other - Prefix:MRS
Other - First Name:MICHELLE
Other - Middle Name:SUSAN
Other - Last Name:ZEIGLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, BSN
Mailing Address - Street 1:PO BOX 600
Mailing Address - Street 2:
Mailing Address - City:TUBA CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86045-0600
Mailing Address - Country:US
Mailing Address - Phone:928-283-2441
Mailing Address - Fax:928-283-2410
Practice Address - Street 1:167 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:TUBA CITY
Practice Address - State:AZ
Practice Address - Zip Code:86045
Practice Address - Country:US
Practice Address - Phone:928-283-2441
Practice Address - Fax:928-283-2410
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA712099163W00000X
CA1795176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No163W00000XNursing Service ProvidersRegistered Nurse