Provider Demographics
NPI:1437945151
Name:MCCOLLUM, MANDY L (RN)
Entity type:Individual
Prefix:MRS
First Name:MANDY
Middle Name:L
Last Name:MCCOLLUM
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 1:825 N EDISON ST STE 130
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-6246
Mailing Address - Country:US
Mailing Address - Phone:509-713-1297
Mailing Address - Fax:
Practice Address - Street 1:825 N EDISON ST STE 130
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-6246
Practice Address - Country:US
Practice Address - Phone:509-713-1297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-18
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care