Provider Demographics
NPI:1750889259
Name:CULLITON, PAMELA JEAN (ARNP-C, RN)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:JEAN
Last Name:CULLITON
Suffix:
Gender:F
Credentials:ARNP-C, RN
Other - Prefix:MRS
Other - First Name:PAMELA
Other - Middle Name:JEAN
Other - Last Name:CULLITON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ARNP-C
Mailing Address - Street 1:650 MARYVILLE UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-5849
Mailing Address - Country:US
Mailing Address - Phone:314-529-9520
Mailing Address - Fax:314-529-9906
Practice Address - Street 1:650 MARYVILLE UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-5849
Practice Address - Country:US
Practice Address - Phone:314-529-9520
Practice Address - Fax:314-529-9906
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-30
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO063680363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health