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Individual
MRS. MILDRED FLEMING MCCULLY
Active
Individual
MRS. MILDRED FLEMING MCCULLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
19766
SC
363LP0200X
Pediatric Nurse Practitioner
300071
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NP3570
—
SC
01
—
SCC6123365
MEDICARE PIN
SC
01
—
SCC6125019
MEDICARE PIN
SC
01
—
SCC612H895
MEDICARE PIN
SC
01
—
SCC612J577
MEDICARE PIN
SC
Enumeration date
01/25/2007
Last updated
06/17/2020
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