| NPI | 1922522093 |
|---|---|
| Former Name | STEPHENEJO SHANUNIELLE MCCULLOCH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA MS4431552) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WA 363LG0600X) |
| Enumeration Date | 2017-07-31 |
| Last Update Date | 2020-01-08 |