Provider Demographics
NPI:1447349519
Name:KULJIAN, NANCY M (NP)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:M
Last Name:KULJIAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:MARIE
Other - Last Name:MARNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:27555 YNEZ RD STE 400
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-4679
Mailing Address - Country:US
Mailing Address - Phone:951-693-4433
Mailing Address - Fax:951-694-6662
Practice Address - Street 1:27555 YNEZ RD STE 400
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-4679
Practice Address - Country:US
Practice Address - Phone:951-693-4433
Practice Address - Fax:951-694-6662
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP12458363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily