MEDICARE: DAVID MCCULLOUGH RN

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	163WE0003X	Emergency Registered Nurse	662745	CA

General Provider Information

NPI Number	:	1942150842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID MCCULLOUGH RN

Provider Business Mailing Address
First Line	:	2723 CLAREMONT DR
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95405-6808
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2285 CHALLENGER WAY
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95407-5418
Country	:	US
Telephone Number	:	707-569-2300
Fax Number	:

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

Provider Enumeration Date	:	01/30/2026
Last Update Date	:	02/10/2026

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