Healthcare Provider Details

I. General information

NPI: 1801987060
Provider Name (Legal Business Name): LESLEY JEAN MULLINS R.N., M.S., CNS.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 03/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 ERIE AVE
CONNERSVILLE IN
47331-3177
US

IV. Provider business mailing address

645 S ROGERS ST
BLOOMINGTON IN
47403-2353
US

V. Phone/Fax

Practice location:
  • Phone: 765-825-4124
  • Fax: 765-825-3649
Mailing address:
  • Phone: 812-339-1691
  • Fax: 812-337-2438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number70000043A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: