Healthcare Provider Details

I. General information

NPI: 1730376435
Provider Name (Legal Business Name): MARCIA E MCCULLOUGH APRN-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2007
Last Update Date: 07/19/2021
Certification Date: 07/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 FARSON ST STE 210
BELPRE OH
45714-1068
US

IV. Provider business mailing address

416 COLEGATE DR BLDG 3
MARIETTA OH
45750-9549
US

V. Phone/Fax

Practice location:
  • Phone: 740-376-5000
  • Fax: 740-376-5002
Mailing address:
  • Phone: 740-568-4814
  • Fax: 740-374-3165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.09586
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.09586
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: