MEDICARE: ERIN MULLIGAN

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	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1740677301
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIN MULLIGAN

Provider Business Mailing Address
First Line	:	4316 N CARLIN SPRINGS RD APT 24
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22203-2035
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4316 N CARLIN SPRINGS RD APT 24
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22203-2035
Country	:	US
Telephone Number	:	843-460-5747
Fax Number	:

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

Provider Enumeration Date	:	04/22/2015
Last Update Date	:	04/22/2015

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