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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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