Provider Demographics
NPI:1588113500
Name:MCCULLOUGH, LYNDSAY MARIE (FNP-C)
Entity type:Individual
Prefix:MISS
First Name:LYNDSAY
Middle Name:MARIE
Last Name:MCCULLOUGH
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:DR
Other - First Name:LYNDSAY
Other - Middle Name:MARIE
Other - Last Name:RADEWONUK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:3802 BROOKFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-1808
Mailing Address - Country:US
Mailing Address - Phone:610-547-0132
Mailing Address - Fax:
Practice Address - Street 1:660 BAYLOR BLVD
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:DE
Practice Address - Zip Code:19720-1140
Practice Address - Country:US
Practice Address - Phone:302-577-3004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-03
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG-0000969363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily