Healthcare Provider Details

I. General information

NPI: 1306196910
Provider Name (Legal Business Name): JENNIFER LYNN CULGIN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2012
Last Update Date: 09/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 SYLVAN ST STE B102
DANVERS MA
01923-2764
US

IV. Provider business mailing address

75 SYLVAN ST STE B102
DANVERS MA
01923-2764
US

V. Phone/Fax

Practice location:
  • Phone: 978-774-7566
  • Fax: 978-774-9346
Mailing address:
  • Phone: 978-774-7566
  • Fax: 978-774-9346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN265521
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: