Individual
JESSICA QUANTZ CULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
205 PALMER AVENUE, BELLEFONTAINE, OH 43311
(937) 599-7018
(937) 599-5011
Mailing address
205 PALMER AVENUE, BELLEFONTAINE, OH 43311
(937) 599-7018
(937) 599-5011
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
35091140
OH
208M00000X
Hospitalist Physician
Primary
35091140
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2866975
—
OH
Enumeration date
02/26/2008
Last updated
07/15/2021
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