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Organization
MID-COLUMBIA DERMATOLOGY, LLC
Active
Organization
MID-COLUMBIA DERMATOLOGY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER MCCULLUGH (MANAGING MEMBER)
(509) 619-5936
Entity
Organization
Contact information
Practice address
309 BRADLEY BLVD, STE 101, RICHLAND, WA 99352-4381
(509) 619-5936
Mailing address
309 BRADLEY BLVD, STE 101, RICHLAND, WA 99352-4381
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
AP60140231
WA
Other
Enumeration date
01/22/2013
Last updated
01/22/2013
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