Individual
COLLEEN MCCULLOUGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
11873 63RD PL N, MAPLE GROVE, MN 55369-6152
(763) 227-9791
Mailing address
11873 63RD PL N, MAPLE GROVE, MN 55369-6152
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/14/2015
Last updated
05/14/2015
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