Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | SP023815 | PA |
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | SP023815 | PA |
NPI | 1104495480 |
---|---|
Provider Name | Renee Ashley Mcculloch |
First Address | York, PA 17402-9001 |
Second Address | York, PA 17403-3676 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2021 |
Last Update Date | 10/08/2021 |