Provider Demographics
NPI:1326106774
Name:MCCULLEY, MARCIA KAY (WHNP)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:KAY
Last Name:MCCULLEY
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:MARCIA
Other - Middle Name:KAY
Other - Last Name:MCCULLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:4832 DUNSMORE AVE
Mailing Address - Street 2:
Mailing Address - City:LA CRESCENTA
Mailing Address - State:CA
Mailing Address - Zip Code:91214-1815
Mailing Address - Country:US
Mailing Address - Phone:818-433-8690
Mailing Address - Fax:818-330-9801
Practice Address - Street 1:6208 SEVILLE AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255
Practice Address - Country:US
Practice Address - Phone:323-588-8855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN 429440163WC1500X, 163WH0200X, 163WI0500X, 163WL0100X, 163WM0102X, 163WP1700X, 163WR0006X, 163WR1000X, 163WW0101X, 163WX0002X, 163WX0003X, 163WR0006X
CA9578363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn
No163WP1700XNursing Service ProvidersRegistered NursePerinatal
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
No163WR1000XNursing Service ProvidersRegistered NurseReproductive Endocrinology/Infertility
No163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory
No163WX0002XNursing Service ProvidersRegistered NurseObstetric, High-Risk
No163WX0003XNursing Service ProvidersRegistered NurseObstetric, Inpatient