Individual
MARY POLLEYS MCCULLOCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NNP
Contact information
Practice address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2088
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
363LN0005X
Critical Care Neonatal Nurse Practitioner
2203014405
UT
363LN0005X
Critical Care Neonatal Nurse Practitioner
289606
AZ
363LN0005X
Critical Care Neonatal Nurse Practitioner
Primary
58268
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
176667
—
AZ
Enumeration date
02/05/2007
Last updated
04/27/2026
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