Healthcare Provider Details

I. General information

NPI: 1518577261
Provider Name (Legal Business Name): ERICA R CIULLA APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2020
Last Update Date: 08/07/2020
Certification Date: 08/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2720 PLAZA DR STE 2100
WAUSAU WI
54401-4157
US

IV. Provider business mailing address

5200 HAMPTON RD
STEVENS POINT WI
54482-8703
US

V. Phone/Fax

Practice location:
  • Phone: 715-847-2475
  • Fax:
Mailing address:
  • Phone: 715-570-4779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number10232
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: