Individual
MS. COURTNEY JOY MCCULLOUGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
W129N7055 NORTHFIELD DR, MENOMONEE FALLS, WI 53051-0538
(414) 777-3750
Mailing address
PO BOX 778789, CHICAGO, IL 60677-8789
(414) 672-1353
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1306257431
—
WI
Enumeration date
05/12/2014
Last updated
06/26/2023
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