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Individual

MS. THERESA JEAN ULICHNEY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
CNP

Contact information

Practice address
420 POLIFKA DR, SHAW AFB, SC 29152
(803) 895-6812
(803) 895-6030
Mailing address
420 POLIFKA DR, SHAW AFB, SC 29152-5100
(803) 895-6812
(803) 895-6030

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
00175079
WA
363LW0102X
Women's Health Nurse Practitioner
A18512
SC
363LW0102X
Women's Health Nurse Practitioner
Primary
AP30007901
WA

Other

Enumeration date
06/24/2006
Last updated
05/24/2018
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