Provider Demographics
NPI:1225819766
Name:MCCULLOUGH, BRIDGETTE N/A (RN CCM)
Entity Type:Individual
Prefix:
First Name:BRIDGETTE
Middle Name:N/A
Last Name:MCCULLOUGH
Suffix:
Gender:F
Credentials:RN CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 HERITAGE TREE LN APT 1410
Mailing Address - Street 2:
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95610-7981
Mailing Address - Country:US
Mailing Address - Phone:916-710-0863
Mailing Address - Fax:
Practice Address - Street 1:3701 POWER INN RD STE 3100
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826-4351
Practice Address - Country:US
Practice Address - Phone:800-707-3358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-10
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA690962163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management