Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 131255 | MO |
N | 363LP0200X | Nurse Practitioner - Pediatrics | 45919 | KS |
NPI | 1013096460 |
---|---|
Provider Name | Lisa Gail Culliton |
First Address | Kansas City, MO 64108-4619 |
Second Address | Kansas City, MO 64108-4619 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2006 |
Last Update Date | 05/11/2015 |