Physician Compare National (NPI:1164648895)

HEALTHCARE PROVIDER: JOANNA MARIE CULLINS PSYD.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1164648895
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	5193949949
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20140911001236
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	CULLINS
	Individual professional last name
Provider First Name	JOANNA
	Individual professional first name
Provider Middle Name	MARIE
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2010
	Individual professional's medical school graduation year
Primary Specialty	PSYCHOLOGIST, CLINICAL
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	9120 NE VANCOUVER
	Group Practice or individual's line 1 address
Line 2 Street Address	MALL LOOP SUITE 261
	Group Practice or individual's line 2 address
City	VANCOUVER
	Group Practice or individual's city
State	WA
	Group Practice or individual's state
Zip Code	986626391
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y