Provider Demographics
NPI:1801156872
Name:CULLINS, MIRANDA SUSANN (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:SUSANN
Last Name:CULLINS
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 GESSNER ROAD
Mailing Address - Street 2:SUITE 525
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024
Mailing Address - Country:US
Mailing Address - Phone:713-722-2253
Mailing Address - Fax:713-973-0805
Practice Address - Street 1:915 GESSNER ROAD
Practice Address - Street 2:SUITE 525
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024
Practice Address - Country:US
Practice Address - Phone:713-722-2253
Practice Address - Fax:713-973-0805
Is Sole Proprietor?:No
Enumeration Date:2012-05-23
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX690004163WI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy