Provider Demographics
NPI:1134155773
Name:ULICHNEY, THERESA JEAN (CNP)
Entity type:Individual
Prefix:MS
First Name:THERESA
Middle Name:JEAN
Last Name:ULICHNEY
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:
Other - Last Name:CADA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:420 POLIFKA DR
Mailing Address - Street 2:
Mailing Address - City:SHAW AFB
Mailing Address - State:SC
Mailing Address - Zip Code:29152-5100
Mailing Address - Country:US
Mailing Address - Phone:803-895-6812
Mailing Address - Fax:803-895-6030
Practice Address - Street 1:420 POLIFKA DR
Practice Address - Street 2:
Practice Address - City:SHAW AFB
Practice Address - State:SC
Practice Address - Zip Code:29152
Practice Address - Country:US
Practice Address - Phone:803-895-6812
Practice Address - Fax:803-895-6030
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-24
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00175079163W00000X
SCA18512363LW0102X
WAAP30007901363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIQ77841Medicare UPIN
HIH102325Medicare PIN