Healthcare Provider Details

I. General information

NPI: 1295190163
Provider Name (Legal Business Name): FRANK CIULLA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2015
Last Update Date: 12/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 KEEWAYDIN DR
SALEM NH
03079-2839
US

IV. Provider business mailing address

2 KEEWAYDIN DR
SALEM NH
03079-2839
US

V. Phone/Fax

Practice location:
  • Phone: 800-995-2673
  • Fax:
Mailing address:
  • Phone: 800-995-2673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number0111516
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLP60591503
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number78552-9
License Number StateMN
# 4
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number282333
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number066608
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: