| Doctor Name: | MRS. ANDREA NICOLE MCCULLOCH |
| NPI Number: | 1104192772 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CPNP |
| License Number: | RN2006021603 |
| Business Practice Address: | 6526 Lansdowne St. Louis, MO - 631092654 |
| Business Phone Number: | 3143538777 |
| Business Fax Number: | 3143538772 |
| Mailing Address: | 6526 Lansdowne, ST. LOUIS |
| State: | MO |
| Postal Code: | 631042654 |
| Phone Number: | 3143538777 |
| Fax Number: | 3143538772 |
| NPI Enumeration Date: | 03/28/2012 |
| NPI Last Update Date: | 12/06/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0200X |
| License Number: | RN2006021603 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Pediatrics |
| Taxonomy Definition: | |