Provider Demographics
NPI:1194940981
Name:CULL, TYLETTE PLESCHELLE (LPN)
Entity type:Individual
Prefix:
First Name:TYLETTE
Middle Name:PLESCHELLE
Last Name:CULL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 W PLEASANT ST APT N8
Mailing Address - Street 2:
Mailing Address - City:MANLIUS
Mailing Address - State:NY
Mailing Address - Zip Code:13104-1731
Mailing Address - Country:US
Mailing Address - Phone:315-692-4629
Mailing Address - Fax:
Practice Address - Street 1:5320 CHRISTIAN DR
Practice Address - Street 2:
Practice Address - City:CAZENOVIA
Practice Address - State:NY
Practice Address - Zip Code:13035-9337
Practice Address - Country:US
Practice Address - Phone:315-655-9192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2587651164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse