Provider Demographics
NPI:1124322425
Name:CULLEN, LAURIE A (PA-C)
Entity type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:A
Last Name:CULLEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 HOSFORD RD
Mailing Address - Street 2:
Mailing Address - City:GALION
Mailing Address - State:OH
Mailing Address - Zip Code:44833-9325
Mailing Address - Country:US
Mailing Address - Phone:419-468-0935
Mailing Address - Fax:419-462-5372
Practice Address - Street 1:955 HOSFORD RD
Practice Address - Street 2:
Practice Address - City:GALION
Practice Address - State:OH
Practice Address - Zip Code:44833
Practice Address - Country:US
Practice Address - Phone:419-468-7059
Practice Address - Fax:419-468-6962
Is Sole Proprietor?:No
Enumeration Date:2010-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0084962Medicaid