Healthcare Provider Details

I. General information

NPI: 1073156675
Provider Name (Legal Business Name): APRIL MCCULLUM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2019
Last Update Date: 10/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16642 MONTE VISTA ST
DETROIT MI
48221-2862
US

IV. Provider business mailing address

16642 MONTE VISTA ST
DETROIT MI
48221-2862
US

V. Phone/Fax

Practice location:
  • Phone: 810-937-6001
  • Fax:
Mailing address:
  • Phone: 810-937-6001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number163WH0200X
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: