Healthcare Provider Details

I. General information

NPI: 1457872541
Provider Name (Legal Business Name): CHRISTINA KULMAN AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTINA BANTLE AGACNP-BC

II. Dates (important events)

Enumeration Date: 06/29/2017
Last Update Date: 07/21/2022
Certification Date: 11/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 PINE GROVE AVENUE EMERGENCY MEDICINE DEPARTMENT
PORT HURON MI
48060-1111
US

IV. Provider business mailing address

1221 PINE GROVE AVE
PORT HURON MI
48060-3511
US

V. Phone/Fax

Practice location:
  • Phone: 810-987-5000
  • Fax: 810-985-2671
Mailing address:
  • Phone: 810-987-5000
  • Fax: 810-985-2671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704286184
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: