Healthcare Provider Details

I. General information

NPI: 1679776280
Provider Name (Legal Business Name): ROBIN WILNER MULLIN R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 VICENTE ST
SAN FRANCISCO CA
94116-2923
US

IV. Provider business mailing address

57 BAYVIEW AVE
LARKSPUR CA
94939-2006
US

V. Phone/Fax

Practice location:
  • Phone: 415-927-0484
  • Fax:
Mailing address:
  • Phone: 415-927-0484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number236670
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: