Provider Demographics
NPI:1215250923
Name:MCCULLOUGH, CATHY LIZABETH (RN)
Entity type:Individual
Prefix:MRS
First Name:CATHY
Middle Name:LIZABETH
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 1:125 N BLOOMFIELD RD
Mailing Address - Street 2:APT. # 15
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-1008
Mailing Address - Country:US
Mailing Address - Phone:585-314-4076
Mailing Address - Fax:
Practice Address - Street 1:150 STATE ST
Practice Address - Street 2:SUITE 140
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14614-1353
Practice Address - Country:US
Practice Address - Phone:585-454-3550
Practice Address - Fax:585-232-4231
Is Sole Proprietor?:No
Enumeration Date:2010-03-09
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY424400-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse