NPI | 1447461314 |
---|---|
Former Name | DARLENE M MCCULLOUGH |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: NC 5009929) |
Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: VA 0024167791) |
363LP0200X Nurse Practitioner, Pediatrics (Licence: TX 579151) | |
Enumeration Date | 2007-05-24 |
Last Update Date | 2020-04-29 |