Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mary Polleys McCulloch, NNP

Individual provider Critical Care Neonatal Nurse Practitioner · NPI 1275672396

Mary Polleys McCulloch, NNP is a Nurse Practitioner in Boise, Idaho. Qualified in 1982, 44 years ago. Works from 3 locations. Licensed in Arizona, Idaho and Utah.

Years since qualifying
44
Licensed in
AZ, ID, UT
In the registry since
2007
Specialties on file
3
Claim this listing Report a problem Suggest an edit

Practice location Address checks out

190 E Bannock St
Boise, ID 83712-6241
Phone: (208) 381-2088
Show map & directions

Directions in Google Maps · Apple Maps · OpenStreetMap

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (2)

  • 14502 W Meeker Blvd, Sun City West, AZ 85375-5282 — (602) 805-2669
  • 50 N Medical Dr, Slc, UT 84132-0001 — (801) 581-6913

Specialties & licences

Critical Care Neonatal Nurse Practitioner (primary) Taxonomy 363LN0005X · Licence 58268 (ID)
Critical Care Neonatal Nurse Practitioner Taxonomy 363LN0005X · Licence 289606 (AZ)
Critical Care Neonatal Nurse Practitioner Taxonomy 363LN0005X · Licence 2203014405 (UT)

Record details

NPI number1275672396
Entity typeIndividual (Type 1)
GenderFemale
Credentials NNP
Sole proprietorNo
NPI enumeratedFebruary 5, 2007
Last updated in NPPESApril 27, 2026
Certification dateApril 27, 2026

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 1982 (44 years in practice)
Accepts Medicare assignment Not indicated
Practice locations2 on file with Medicare

Other providers in Boise