Individual
ERIKA MCCULLOUGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
16447 84TH ST, BRISTOL, WI 53104-9168
(262) 818-1905
Mailing address
16447 84TH ST, BRISTOL, WI 53104-9168
(262) 818-1905
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
319678
WI
Other
Enumeration date
12/26/2015
Last updated
12/26/2015
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