Provider Demographics
NPI:1578273819
Name:MCCULLOUGH, RHYAN DESERIE
Entity Type:Individual
Prefix:
First Name:RHYAN
Middle Name:DESERIE
Last Name:MCCULLOUGH
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 1:227 ELLER AVE
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45322-1728
Mailing Address - Country:US
Mailing Address - Phone:937-312-5615
Mailing Address - Fax:
Practice Address - Street 1:227 ELLER AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:OH
Practice Address - Zip Code:45322-1728
Practice Address - Country:US
Practice Address - Phone:937-312-5615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion