Individual
LEVONE MCCULLOUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
18101 OAKWOOD BLVD, DEARBORN, MI 48124-4089
(313) 593-7000
Mailing address
38935 ANN ARBOR RD, LIVONIA, MI 48150-3354
(734) 632-0175
(734) 632-0182
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704188362
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10-4257067
—
MI
05
—
10-4257076
—
MI
05
—
10-4257085
—
MI
05
—
10-4257094
—
MI
05
—
10-4257100
—
MI
05
—
10-4584187
—
MI
05
—
11-4941074
—
MI
05
—
11-4941083
—
MI
05
—
11-4941092
—
MI
05
—
11-4941109
—
MI
01
—
5008666750
BCBS
MI
Enumeration date
01/06/2006
Last updated
07/09/2007
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