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General NPI Number Information
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NPI Number | 1548501745
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Entity Type | Individual
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Provider Name | MARIA FLORDESOL ABULOC CULPA-BONDAL RN, PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 03/13/2013
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Last Update Date | 01/28/2021
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Provider Practice Location Address
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Address Line | 145 STONE BROOKE DR
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City | GRAY
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State | GA
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Zip | 31032-5864
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Country | US
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Telephone | 478-986-2776
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Fax |
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Provider Business Mailing Address
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Address Line | 145 STONE BROOKE DR
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City | GRAY
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State | GA
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Zip | 31032-5864
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Country | US
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Telephone | 478-986-2776
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Fax |
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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 | 364SP0808X
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Taxonomy Name | Psychiatric/Mental Health Clinical Nurse Specialist
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License Number | RN109284
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | RN109284
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License Number State | GA
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