Provider Demographics
NPI:1821365511
Name:CULLIVER, STELLA SUZANNE (ADULT PSYCH NP)
Entity type:Individual
Prefix:MRS
First Name:STELLA
Middle Name:SUZANNE
Last Name:CULLIVER
Suffix:
Gender:F
Credentials:ADULT PSYCH NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12034 BIG CANOE
Mailing Address - Street 2:
Mailing Address - City:BIG CANOE
Mailing Address - State:GA
Mailing Address - Zip Code:30143-5154
Mailing Address - Country:US
Mailing Address - Phone:808-777-9460
Mailing Address - Fax:808-217-9174
Practice Address - Street 1:928 NUUANU AVE STE 202
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-5190
Practice Address - Country:US
Practice Address - Phone:808-777-9460
Practice Address - Fax:808-217-9174
Is Sole Proprietor?:No
Enumeration Date:2011-11-23
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR857154363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health