Healthcare Provider Details

I. General information

NPI: 1720253206
Provider Name (Legal Business Name): KAREN SUE MULLIN MACCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2008
Last Update Date: 04/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3950 KRESGE WAY #402
LOUISVILLE KY
40207-4637
US

IV. Provider business mailing address

3950 KRESGE WAY #402
LOUISVILLE KY
40207-4637
US

V. Phone/Fax

Practice location:
  • Phone: 502-893-3683
  • Fax: 502-893-1662
Mailing address:
  • Phone: 502-893-3683
  • Fax: 502-893-1662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number0431
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: