Healthcare Provider Details

I. General information

NPI: 1497846349
Provider Name (Legal Business Name): PATRICIA LYNN MULLEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 12/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 KAMANI ST
PAHALA HI
96777
US

IV. Provider business mailing address

PO BOX 40
PAHALA HI
96777-0040
US

V. Phone/Fax

Practice location:
  • Phone: 808-932-4200
  • Fax: 808-928-8980
Mailing address:
  • Phone: 808-932-4200
  • Fax: 808-928-8980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number15423
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberG49523
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: