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Individual

JONATHAN MCCULLY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PMHNP

Contact information

Practice address
61822 TEN BARR RANCH RD, BEND, OR 97701-9314
(541) 419-4054
Mailing address
61822 TEN BARR RANCH RD, BEND, OR 97701-9314
(541) 419-4054

Taxonomy

Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
202010015NP-PP
OR

Other

Enumeration date
01/14/2021
Last updated
04/17/2024
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