Basic Information
Provider Information
NPI: 1003003492
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CULHANE
FirstName: ANNEMARIE
MiddleName:  
NamePrefix: MRS.
NameSuffix:  
Credential: R.N.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 118 ENOCH CROSBY RD
Address2:  
City: BREWSTER
State: NY
PostalCode: 105092140
CountryCode: US
TelephoneNumber: 9145221202
FaxNumber: 8452781417
Practice Location
Address1: 118 ENOCH CROSBY RD
Address2:  
City: BREWSTER
State: NY
PostalCode: 105092140
CountryCode: US
TelephoneNumber: 9145221202
FaxNumber: 8452781417
Other Information
ProviderEnumerationDate: 09/28/2007
LastUpdateDate: 09/28/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000X309860NYY Nursing Service ProvidersRegistered Nurse 

ID Information
IDTypeStateIssuerDescription
0123479305NY MEDICAID


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