Individual
MARY A MCCULLOUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP
Contact information
Practice address
753 POINTE BASSE DR, STE GENEVIEVE, MO 63670-1820
(573) 883-4477
(573) 883-4472
Mailing address
PO BOX 366, STE GENEVIEVE, MO 63670-0366
(573) 883-4477
(573) 883-4472
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
RN097885
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
591649108
—
MO
01
—
CC8331
RR MEDICARE
MO
Enumeration date
01/15/2007
Last updated
04/18/2013
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