Basic Information
| Provider Information | |||||||||
| NPI: | 1407076417 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CULLINAN | ||||||||
| FirstName: | DONNA | ||||||||
| MiddleName: | M. | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 103 GREAT PLAIN AVENUE | ||||||||
| Address2: | |||||||||
| City: | WELLESLY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02482 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7812393286 | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 HIGHLAND STREET | ||||||||
| Address2: | SUITE 209 | ||||||||
| City: | MILTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02186 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6176964600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 134138 | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.