Provider Demographics
NPI:1326359068
Name:MCCULLOUGH, MARGARET M (LPN)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:M
Last Name:MCCULLOUGH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 552
Mailing Address - Street 2:255 PENALUNA RD
Mailing Address - City:GREENWOOD LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:10925-0552
Mailing Address - Country:US
Mailing Address - Phone:845-494-3536
Mailing Address - Fax:
Practice Address - Street 1:255 PENALUNA RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950-0552
Practice Address - Country:US
Practice Address - Phone:845-494-3536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-28
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY285000164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse