Provider Demographics
NPI:1992506711
Name:CULLEN, ELIZABETH A
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:CULLEN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2115 S 113TH AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-3029
Mailing Address - Country:US
Mailing Address - Phone:402-659-2934
Mailing Address - Fax:
Practice Address - Street 1:18151 LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:NE
Practice Address - Zip Code:68022-1605
Practice Address - Country:US
Practice Address - Phone:402-740-9659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-19
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant