Individual
MRS. KELLY R MCCULLOUGH BANKSTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.N.
Contact information
Practice address
23585 CANNON RD, BEDFORD HTS, OH 44146-1631
(216) 551-1293
Mailing address
23585 CANNON RD, BEDFORD HTS, OH 44146-1631
(216) 551-1293
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
366051
OH
Other
Enumeration date
12/03/2010
Last updated
12/03/2010
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