Provider Demographics
NPI:1285519603
Name:VENUS COLLECTIVE WOMEN'S HEALTH AND INTIMACY
Entity type:Organization
Organization Name:VENUS COLLECTIVE WOMEN'S HEALTH AND INTIMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:TULL
Authorized Official - Suffix:
Authorized Official - Credentials:WHNP
Authorized Official - Phone:812-236-7743
Mailing Address - Street 1:22 NORTH DR
Mailing Address - Street 2:
Mailing Address - City:STURBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01518-1161
Mailing Address - Country:US
Mailing Address - Phone:812-236-7743
Mailing Address - Fax:
Practice Address - Street 1:22 NORTH DR
Practice Address - Street 2:
Practice Address - City:STURBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01518-1161
Practice Address - Country:US
Practice Address - Phone:812-236-7743
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-06
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Single Specialty