Provider Demographics
NPI:1730921370
Name:CULLEN, GINGER LARAINE (BSM, LM, CPM)
Entity type:Individual
Prefix:MS
First Name:GINGER
Middle Name:LARAINE
Last Name:CULLEN
Suffix:
Gender:F
Credentials:BSM, LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:346 E LEADORA LN
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-2113
Mailing Address - Country:US
Mailing Address - Phone:360-929-4977
Mailing Address - Fax:
Practice Address - Street 1:1048 N 3RD ST
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-3110
Practice Address - Country:US
Practice Address - Phone:208-699-3625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-12
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMID-162176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife