Healthcare Provider Details

I. General information

NPI: 1306154976
Provider Name (Legal Business Name): CHRISTINE MARIE KULLE MSN, RN, NP-C, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTINE MARIE KULLE-MERLESENA MSN, RN, NP-C, CNM

II. Dates (important events)

Enumeration Date: 09/17/2010
Last Update Date: 11/30/2020
Certification Date: 11/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

476 E CAMPBELL AVE
CAMPBELL CA
95008-2142
US

IV. Provider business mailing address

476 E CAMPBELL AVE
CAMPBELL CA
95008-2142
US

V. Phone/Fax

Practice location:
  • Phone: 408-871-5040
  • Fax: 408-871-5049
Mailing address:
  • Phone: 408-871-5040
  • Fax: 408-871-5049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number20185
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number1200
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: