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General NPI Number Information
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NPI Number | 1013972892
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Entity Type | Individual
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Provider Name | MICHELLE SUSAN CULLISON CNM, MSN
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Gender | Female
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Dates
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Enumeration Date | 04/18/2006
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Last Update Date | 11/02/2025
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Provider Practice Location Address
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Address Line | 167 NORTH MAIN STREET
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City | TUBA CITY
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State | AZ
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Zip | 86045
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Country | US
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Telephone | 928-283-2441
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Fax | 928-283-2410
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Provider Business Mailing Address
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Address Line | PO BOX 600
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City | TUBA CITY
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State | AZ
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Zip | 86045-0600
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Country | US
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Telephone | 928-283-2441
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Fax | 928-283-2410
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 712099
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 176B00000X
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Taxonomy Name | Midwife
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License Number | 1795
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License Number State | CA
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