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NPI Code Detail

MEDICARE: DR. MARY PATRICIA MULLIN DNP, FNP-BC, RN

MEDICARE: DR. MARY PATRICIA MULLIN DNP, FNP-BC, RN
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
1363LF0000XFamily Nurse Practitioner4704190831MI

General Provider Information

NPI Number : 1598929473
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARY PATRICIA MULLIN DNP, FNP-BC, RN
Provider Business Mailing Address
First Line : 21535 SUMMERSIDE LN
Second Line :
City : NORTHVILLE
State : MI
Zip : 48167-1055
Country : US
Telephone Number : 248-444-4720
Fax Number :
Provider Business Practice Location Address
First Line : 250 MONROE AVE NW STE 400
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49503-2293
Country : US
Telephone Number : 248-444-4720
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/10/2008
Last Update Date : 10/13/2020

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