Provider Demographics
NPI:1073156675
Name:MCCULLUM, APRIL
Entity Type:Individual
Prefix:
First Name:APRIL
Middle Name:
Last Name:MCCULLUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16642 MONTE VISTA ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48221-2862
Mailing Address - Country:US
Mailing Address - Phone:810-937-6001
Mailing Address - Fax:
Practice Address - Street 1:16642 MONTE VISTA ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48221-2862
Practice Address - Country:US
Practice Address - Phone:810-937-6001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-26
Last Update Date:2019-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI163WH0200X374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI9126740Medicaid