Provider Demographics
NPI:1407076417
Name:CULLINAN, DONNA M (NP)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:M
Last Name:CULLINAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 GREAT PLAIN AVENUE
Mailing Address - Street 2:
Mailing Address - City:WELLESLY
Mailing Address - State:MA
Mailing Address - Zip Code:02482
Mailing Address - Country:US
Mailing Address - Phone:781-239-3286
Mailing Address - Fax:
Practice Address - Street 1:100 HIGHLAND STREET
Practice Address - Street 2:SUITE 209
Practice Address - City:MILTON
Practice Address - State:MA
Practice Address - Zip Code:02186
Practice Address - Country:US
Practice Address - Phone:617-696-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA134138363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner