Provider Demographics
NPI:1992922058
Name:CULLAN, SHANNON H (NP)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:H
Last Name:CULLAN
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 1:4121 THORN CT
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68520-9322
Mailing Address - Country:US
Mailing Address - Phone:402-419-9885
Mailing Address - Fax:
Practice Address - Street 1:4121 THORN CT
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68520-9322
Practice Address - Country:US
Practice Address - Phone:402-419-9885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE111105363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANP17174OtherNP LICENSE