Healthcare Provider Details

I. General information

NPI: 1922942614
Provider Name (Legal Business Name): DAWN MARIE MCCULLOUGH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2026
Last Update Date: 10/03/2026
Certification Date: 10/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

178 VIRGINIA RD
CONCORD MA
01742-2717
US

IV. Provider business mailing address

178 VIRGINIA RD
CONCORD MA
01742-2717
US

V. Phone/Fax

Practice location:
  • Phone: 617-610-0128
  • Fax:
Mailing address:
  • Phone: 617-610-0128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN231429
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: