MEDICARE: MR. JEFFREY STEPHEN MCCULLAR NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	COA 18816-NP	OH

General Provider Information

NPI Number	:	1528428026
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEFFREY STEPHEN MCCULLAR NP

Provider Business Mailing Address
First Line	:	82 W STREETSBORO ST
Second Line	:
City	:	HUDSON
State	:	OH
Zip	:	44236-2876
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	82 W STREETSBORO ST
Second Line	:
City	:	HUDSON
State	:	OH
Zip	:	44236-2876
Country	:	US
Telephone Number	:	330-344-7650
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/26/2016
Last Update Date	:	06/14/2021

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