Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 1435 | ND |
NPI | 1023171626 |
---|---|
Provider Name | Mrs. Elizabeth A Mcculley |
First Address | Grand Forks, ND 58206 |
Second Address | Grand Forks, ND 58206-6002 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/12/2006 |
Last Update Date | 08/07/2007 |