Individual
KIM LEE MCCULLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
22101 MOROSS RD, DETROIT, MI 48236-2148
(313) 343-4400
Mailing address
22101 MOROSS RD, DETROIT, MI 48236-2148
(313) 343-4000
Taxonomy
Speciality
Code
Description
License number
State
363LN0000X
Neonatal Nurse Practitioner
Primary
4704207081
MI
363LN0005X
Critical Care Neonatal Nurse Practitioner
4704207081
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4704207081
BLUE CROSS GROUP 0N11180
MI
Enumeration date
10/28/2008
Last updated
09/14/2020
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