Basic Information
Provider Information | |||||||||
NPI: | 1003092255 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | NULK | ||||||||
FirstName: | CHRISTINA | ||||||||
MiddleName: | MARIE | ||||||||
NamePrefix: | MS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.S., BCBA | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 13695 | ||||||||
Address2: |   | ||||||||
City: | FT CARSON | ||||||||
State: | CO | ||||||||
PostalCode: | 809020695 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7192719975 | ||||||||
FaxNumber: | 7194044126 | ||||||||
Practice Location | |||||||||
Address1: | 6050 ERIN PARK DR | ||||||||
Address2: |   | ||||||||
City: | COLORADO SPRINGS | ||||||||
State: | CO | ||||||||
PostalCode: | 809183488 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7194653989 | ||||||||
FaxNumber: | 7193758499 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/18/2008 | ||||||||
LastUpdateDate: | 05/01/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 0384258 | CO | N |   | Other Service Providers | Specialist |   | 3747P1801X |   |   | N |   | Nursing Service Related Providers | Technician | Personal Care Attendant | 103K00000X |   |   | Y |   | Behavioral Health & Social Service Providers | Behavioral Analyst |   |
No ID Information.