Individual
PEGGY LISA MCCULLUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNM
Contact information
Practice address
3640 NW SAMARITAN DR STE 220, CORVALLIS, OR 97330-3784
(541) 768-5300
Mailing address
PO BOX 1189, CORVALLIS, OR 97339-1189
Taxonomy
Speciality
Code
Description
License number
State
176B00000X
Midwife
Primary
200450148NP
OR
367A00000X
Advanced Practice Midwife
200450148NP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200442216RN
STATE LICENSE
OR
01
—
200450148NP
STATE LICENSE
OR
05
—
269512
—
OR
Enumeration date
06/01/2006
Last updated
11/10/2020
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