MEDICARE: RIMMA CULLITON NP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	4704310487	MI

General Provider Information

NPI Number	:	1912677048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RIMMA CULLITON NP-C

Provider Business Mailing Address
First Line	:	4256 HILL DR APT 201
Second Line	:
City	:	SHELBY TOWNSHIP
State	:	MI
Zip	:	48317-4825
Country	:	US
Telephone Number	:	586-453-2619
Fax Number	:

Provider Business Practice Location Address
First Line	:	4256 HILL DR APT 201
Second Line	:
City	:	SHELBY TOWNSHIP
State	:	MI
Zip	:	48317-4825
Country	:	US
Telephone Number	:	586-453-2619
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2021
Last Update Date	:	09/20/2021

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