Provider Demographics
NPI:1396308045
Name:CULLITY, MADELINE MARTIN (PNP)
Entity type:Individual
Prefix:MS
First Name:MADELINE
Middle Name:MARTIN
Last Name:CULLITY
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 7412011
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-2011
Mailing Address - Country:US
Mailing Address - Phone:314-454-6050
Mailing Address - Fax:855-887-7850
Practice Address - Street 1:1 CHILDRENS PL
Practice Address - Street 2:DIV PED INFECTIOUS DISEASE
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1002
Practice Address - Country:US
Practice Address - Phone:314-454-6050
Practice Address - Fax:855-887-7850
Is Sole Proprietor?:No
Enumeration Date:2019-04-18
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019017176363LP0200X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO420069388Medicaid