Provider Demographics
NPI:1811053366
Name:CULKINS, JAYNE D (PA)
Entity type:Individual
Prefix:MS
First Name:JAYNE
Middle Name:D
Last Name:CULKINS
Suffix:
Gender:F
Credentials:PA
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 2430
Mailing Address - Street 2:
Mailing Address - City:NANTUCKET
Mailing Address - State:MA
Mailing Address - Zip Code:02584-2430
Mailing Address - Country:US
Mailing Address - Phone:508-228-8589
Mailing Address - Fax:
Practice Address - Street 1:57 PROSPECT STREET
Practice Address - Street 2:NANTUCKET COTTAGE HOSPITAL
Practice Address - City:NANTUCKET
Practice Address - State:MA
Practice Address - Zip Code:02554
Practice Address - Country:US
Practice Address - Phone:508-825-8165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1539363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAQ35942Medicare UPIN
MAAP 2359Medicare ID - Type Unspecified