Healthcare Provider Details

I. General information

NPI: 1245285162
Provider Name (Legal Business Name): JANELLE CULJIS ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5342 DUDLEY BLVD
MCCLELLAN CA
95652-1012
US

IV. Provider business mailing address

430 GAYLORD CT
SACRAMENTO CA
95864-6014
US

V. Phone/Fax

Practice location:
  • Phone: 916-561-7522
  • Fax: 916-561-7529
Mailing address:
  • Phone: 916-973-0418
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number265121
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: