Healthcare Provider Details

I. General information

NPI: 1144974726
Provider Name (Legal Business Name): COLLEEN MARY-SKIPPY CULLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2022
Last Update Date: 02/11/2022
Certification Date: 02/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 COOLIDGE RD
EAST LANSING MI
48823-6376
US

IV. Provider business mailing address

3500 COOLIDGE RD
EAST LANSING MI
48823-6376
US

V. Phone/Fax

Practice location:
  • Phone: 517-203-4042
  • Fax:
Mailing address:
  • Phone: 517-203-4042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License Number4704268524
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: