Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | AP127965 | TX |
N | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | AP127965 | TX |
NPI | 1104212448 |
---|---|
Provider Name | Stacey Cullins |
First Address | Corpus Christi, TX 78411-1721 |
Second Address | Corpus Christi, TX 78414-4124 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2015 |
Last Update Date | 26/04/2021 |