Healthcare Provider Details

I. General information

NPI: 1336706167
Provider Name (Legal Business Name): CULLEN GETTINGS NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: CULLEN MATTHEW GETTINGS

II. Dates (important events)

Enumeration Date: 05/28/2019
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2799 W GRAND BLVD # H-1
DETROIT MI
48202-2608
US

IV. Provider business mailing address

PO BOX 670884
DETROIT MI
48267-0884
US

V. Phone/Fax

Practice location:
  • Phone: 313-916-7926
  • Fax:
Mailing address:
  • Phone: 313-874-4806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number4704351172
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704351172
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: