Provider Demographics
NPI:1184993446
Name:MCCULLOUGH, MAUREEN ELNA (RN )
Entity type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:ELNA
Last Name:MCCULLOUGH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:MAUREEN
Other - Middle Name:ELNA
Other - Last Name:MANNING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4281 KATELLA AVE.
Mailing Address - Street 2:SUTIE 120
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720
Mailing Address - Country:US
Mailing Address - Phone:562-467-5577
Mailing Address - Fax:
Practice Address - Street 1:4281 KATELLA AVE.
Practice Address - Street 2:SUTIE 120
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720
Practice Address - Country:US
Practice Address - Phone:562-467-5577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-15
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA606201163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse