# MID-COLUMBIA DERMATOLOGY, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1033457395
- **Authorized official:** JENNIFER MCCULLUGH (MANAGING MEMBER)
- **Authorized official phone:** (509) 619-5936

## Contact information

- **Practice address:** 309 BRADLEY BLVD, STE 101, RICHLAND, WA 99352-4381
- **Practice address phone:** (509) 619-5936
- **Mailing address:** 309 BRADLEY BLVD, STE 101, RICHLAND, WA 99352-4381

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | AP60140231 | WA | Yes |

## Other

- **Enumeration date:** 01/22/2013
- **Last updated:** 01/22/2013