MEDICARE: SOPHIA MULLEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1386126753
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOPHIA MULLEN

Provider Business Mailing Address
First Line	:	4749 16TH AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55407-3606
Country	:	US
Telephone Number	:	804-467-4592
Fax Number	:

Provider Business Practice Location Address
First Line	:	333 WASHINGTON AVE N
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55401-2263
Country	:	US
Telephone Number	:	612-825-4792
Fax Number	:	626-727-7535

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/03/2018
Last Update Date	:	06/05/2026

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Directions to “ SOPHIA MULLEN ” Practice Location

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