MEDICARE: MRS. SHANNON H CULLAN NP

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	363L00000X	Nurse Practitioner	111105	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NP17174	OTHER	CA	NP LICENSE

General Provider Information

NPI Number	:	1992922058
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHANNON H CULLAN NP

Provider Business Mailing Address
First Line	:	4121 THORN CT
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68520-9322
Country	:	US
Telephone Number	:	402-419-9885
Fax Number	:

Provider Business Practice Location Address
First Line	:	4121 THORN CT
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68520-9322
Country	:	US
Telephone Number	:	402-419-9885
Fax Number	:

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

Provider Enumeration Date	:	04/19/2007
Last Update Date	:	03/18/2021

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