Provider Demographics
NPI:1548021900
Name:CULLUM, THERESE MARIE (CNP)
Entity type:Individual
Prefix:
First Name:THERESE
Middle Name:MARIE
Last Name:CULLUM
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:THERESE
Other - Middle Name:MARIE
Other - Last Name:KOHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:800 GARFIELD AVE # G101
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-5376
Mailing Address - Country:US
Mailing Address - Phone:304-424-4721
Mailing Address - Fax:
Practice Address - Street 1:800 GARFIELD AVE # G101
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-5376
Practice Address - Country:US
Practice Address - Phone:304-424-4721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-22
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV118460363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily