Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 1795 | CA |
NPI | 1013972892 |
---|---|
Provider Name | Mrs. Michelle Susan Cullison |
First Address | Tuba City, AZ 86045-0600 |
Second Address | Tuba City, AZ 86045 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2006 |
Last Update Date | 29/09/2009 |