Provider Demographics
NPI:1134215486
Name:CULLEN, MAUREEN (NP)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:CULLEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 ROPE FERRY RD
Mailing Address - Street 2:#6143
Mailing Address - City:HANOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03755-1404
Mailing Address - Country:US
Mailing Address - Phone:603-646-9400
Mailing Address - Fax:603-646-9450
Practice Address - Street 1:7 ROPE FERRY RD
Practice Address - Street 2:#6143
Practice Address - City:HANOVER
Practice Address - State:NH
Practice Address - Zip Code:03755-1404
Practice Address - Country:US
Practice Address - Phone:603-646-9400
Practice Address - Fax:603-646-9450
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH5270821363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30342730Medicaid
H06749OtherHARVARD PILGRIM
9315957OtherPHCS ID
23YP05362NH01OtherANTHEM ID - NHC
06463647OtherTRICARE
795912OtherMVP ID
795912OtherMVP ID
795912OtherMVP ID
NHQ07069Medicare UPIN