Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LP0200X | Nurse Practitioner - Pediatrics | 448484 | CA |
Y | 363LP0222X | Nurse Practitioner Pediatrics (Critical Care) | 448484 | CA |
NPI | 1043525603 |
---|---|
Provider Name | Ms. Mary Evelyn Mcculley |
First Address | Los Angeles, CA 90027-6062 |
Second Address | Los Angeles, CA 90027-6062 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2010 |
Last Update Date | 06/08/2010 |