Provider Demographics
NPI:1700468980
Name:CULLEN, CARLY E (LPN)
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:E
Last Name:CULLEN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 MILES ST
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01301-3241
Mailing Address - Country:US
Mailing Address - Phone:413-774-3321
Mailing Address - Fax:413-774-3345
Practice Address - Street 1:50 MILES ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-3241
Practice Address - Country:US
Practice Address - Phone:413-774-3321
Practice Address - Fax:413-774-3345
Is Sole Proprietor?:No
Enumeration Date:2021-04-27
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN98326164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse