Healthcare Provider Details

I. General information

NPI: 1669954301
Provider Name (Legal Business Name): EMILY OLIVIA MULDER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2018
Last Update Date: 08/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3520 OAKS WAY APT 904
POMPANO BEACH FL
33069-5387
US

IV. Provider business mailing address

7836 SWIFTRUN RD
COLORADO SPRINGS CO
80920-7124
US

V. Phone/Fax

Practice location:
  • Phone: 305-807-1909
  • Fax:
Mailing address:
  • Phone: 719-331-8183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: