Healthcare Provider Details

I. General information

NPI: 1396344289
Provider Name (Legal Business Name): JORDANA MARIE CULANCULAN ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2020
Last Update Date: 11/03/2025
Certification Date: 10/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BARNES JEWISH HOSPITAL PLZ DIV NEUROLOGY, CRITICAL CARE MEDICINE
SAINT LOUIS MO
63110-1003
US

IV. Provider business mailing address

PO BOX 7412011
CHICAGO IL
60674-2011
US

V. Phone/Fax

Practice location:
  • Phone: 314-362-1408
  • Fax: 314-362-6033
Mailing address:
  • Phone: 314-362-1408
  • Fax: 314-362-6033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number2020035062
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: