MARY ELIZABETH MCCULLOCH NNP NPI 1275672396

NPI Information

NPI: 1275672396
Provider Name: MARY ELIZABETH MCCULLOCH, NNP
Classification: Nurse Practitioner - 363LN0005X
Entity Type: Individual

Specialization: Neonatal, Critical Care

PECOS Registration: Yes

Address:
190 E BANNOCK ST
BOISE, ID
ZIP 83712
Phone: (208) 381-2088
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Mary Elizabeth Mcculloch, NNP is a neonatal and critical care nurse practitioner in Boise, ID. Mary Elizabeth Mcculloch, NNP NPI is 1275672396. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

190 E BANNOCK ST
BOISE, ID
ZIP 83712-241
Phone: (208) 381-2088

The NPI 1275672396 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 2/5/2007 and was last updated on 8/29/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LN0005X	Nurse Practitioner	Neonatal, Critical Care	58268	IDAHO	Yes
2	363LN0005X	Nurse Practitioner	Neonatal, Critical Care	2203014405	UTAH	No

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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