Healthcare Provider Details
I. General information
NPI: 1326106774
Provider Name (Legal Business Name): MARCIA KAY MCCULLEY WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 12/05/2006
Last Update Date: 08/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
6208 SEVILLE AVE
HUNTINGTON PARK CA
90255
US
IV. Provider business mailing address
4832 DUNSMORE AVE
LA CRESCENTA CA
91214-1815
US
V. Phone/Fax
- Phone: 323-588-8855
- Fax:
- Phone: 818-433-8690
- Fax: 818-330-9801
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WC1500X |
| Taxonomy | Community Health Registered Nurse |
| License Number | RN 429440 |
| License Number State | CA |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WH0200X |
| Taxonomy | Home Health Registered Nurse |
| License Number | RN 429440 |
| License Number State | CA |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WI0500X |
| Taxonomy | Infusion Therapy Registered Nurse |
| License Number | RN 429440 |
| License Number State | CA |
| # 4 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WL0100X |
| Taxonomy | Lactation Consultant (Registered Nurse) |
| License Number | RN 429440 |
| License Number State | CA |
| # 5 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WM0102X |
| Taxonomy | Maternal Newborn Registered Nurse |
| License Number | RN 429440 |
| License Number State | CA |
| # 6 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WP1700X |
| Taxonomy | Perinatal Registered Nurse |
| License Number | RN 429440 |
| License Number State | CA |
| # 7 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WR0006X |
| Taxonomy | Registered Nurse First Assistant |
| License Number | RN 429440 |
| License Number State | CA |
| # 8 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WR1000X |
| Taxonomy | Reproductive Endocrinology/Infertility Registered Nurse |
| License Number | RN 429440 |
| License Number State | CA |
| # 9 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WW0101X |
| Taxonomy | Ambulatory Women's Health Care Registered Nurse |
| License Number | RN 429440 |
| License Number State | CA |
| # 10 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WX0002X |
| Taxonomy | High-Risk Obstetric Registered Nurse |
| License Number | RN 429440 |
| License Number State | CA |
| # 11 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WX0003X |
| Taxonomy | Inpatient Obstetric Registered Nurse |
| License Number | RN 429440 |
| License Number State | CA |
| # 12 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 363LW0102X |
| Taxonomy | Women's Health Nurse Practitioner |
| License Number | 9578 |
| License Number State | CA |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone:
