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General NPI Number Information
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NPI Number | 1427396068
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Entity Type | Individual
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Provider Name | MAIJA CARRIE KULP APRN
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Gender | Female
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Dates
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Enumeration Date | 01/16/2013
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Last Update Date | 01/12/2017
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Provider Practice Location Address
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Address Line | 4704 HOEN AVE
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City | SANTA ROSA
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State | CA
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Zip | 95405-7824
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Country | US
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Telephone | 707-546-7979
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Fax | 707-546-7667
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Provider Business Mailing Address
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Address Line | 4704 HOEN AVE
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City | SANTA ROSA
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State | CA
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Zip | 95405-7824
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Country | US
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Telephone | 707-546-7979
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Fax | 707-546-7667
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 209010270
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 3009369
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | NP95005696
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License Number State | CA
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