Dominise McCullough, RN

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

247508-30 Issued in WI

Practice address

2718 Old Camden SQ
Madison, WI 53718-7954

Phone

(608) 514-5697

NPI assigned

Mar 11, 2016

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1457654400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574380800000",
    "number": "1013378553",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2718 OLD CAMDEN SQ",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537187954",
            "telephone_number": "608-514-5697"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2718 OLD CAMDEN SQ",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537187954",
            "telephone_number": "608-514-5697"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "227 Walnut St",
            "address_2": "Apt 2",
            "address_purpose": "LOCATION",
            "city": "Oregon",
            "state": "WI",
            "postal_code": "535751337",
            "country_code": "US",
            "telephone_number": "608-957-9489",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCCULLOUGH",
        "first_name": "DOMINISE",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-03-11",
        "last_updated": "2019-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "WI",
            "license": "315839-31",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "WI",
            "license": "247508-30",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David Michael McCrumb
• Eric T. McCue, PA-C
• Kaitlin Chelsea McCulley
• Connie Sue McCullick, APNP
• Timothy M McCulloch, MD
• Kirsten McCullough, MD
• Sinceray McCullough, PSS
• Emily J. McCutcheon, PA-C
• Mary Beth McDade, LMT
• Sarah A McDaniels, PHD

• Registered Nurse in Madison, WI
• Providers in Madison, WI by specialty
• Registered Nurse in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.