Individual
JENNIFER RENEA MCCULLOUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
4745 S 3200 W, TAYLORSVILLE, UT 84129-2822
(801) 964-6214
(801) 746-0420
Mailing address
2621 S 3270 W, WEST VALLEY CITY, UT 84119-1119
(385) 261-2737
(801) 746-0420
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
5643351-3102
UT
363LP2300X
Primary Care Nurse Practitioner
Primary
5643351-4405
UT
Other
Enumeration date
07/16/2019
Last updated
12/21/2020
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