Healthcare Provider Details

I. General information

NPI: 1275889123
Provider Name (Legal Business Name): JENNIFER MULHAUSEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2012
Last Update Date: 10/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 S QUEBEC ST # A3-798
CENTENNIAL CO
80112-4411
US

IV. Provider business mailing address

8200 S QUEBEC ST # A3-798
CENTENNIAL CO
80112-4411
US

V. Phone/Fax

Practice location:
  • Phone: 720-870-0280
  • Fax:
Mailing address:
  • Phone: 720-870-0280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberDR.0052953
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: