Provider Demographics
NPI:1750945754
Name:MCCULLOUGH, LEONA (RN)
Entity type:Individual
Prefix:
First Name:LEONA
Middle Name:
Last Name:MCCULLOUGH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25400 EUCLID AVE APT 268
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-2614
Mailing Address - Country:US
Mailing Address - Phone:216-225-1468
Mailing Address - Fax:
Practice Address - Street 1:25400 EUCLID AVE APT 268
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44117-2614
Practice Address - Country:US
Practice Address - Phone:216-225-1468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-24
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.436069163WC0400X, 163WH0200X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
No163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Single Specialty
No163WH0200XNursing Service ProvidersRegistered NurseHome Health