Healthcare Provider Details

I. General information

NPI: 1548282718
Provider Name (Legal Business Name): ELIZABETH MARY CULLITY ARNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 03/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 SPRINGS ROAD
BEDFORD MA
01730
US

IV. Provider business mailing address

200 SPRINGS ROAD VAMC
BEDFORD MA
01730-1114
US

V. Phone/Fax

Practice location:
  • Phone: 781-275-7500
  • Fax:
Mailing address:
  • Phone: 800-838-6331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number161092
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number053094-23-05
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: