Healthcare Provider Details

I. General information

NPI: 1558329755
Provider Name (Legal Business Name): JUDITH MULLINS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 04/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 MOUNT AUBURN ST CENTER FOR WOMEN
CAMBRIDGE MA
02138-5502
US

IV. Provider business mailing address

330 MOUNT AUBURN ST
CAMBRIDGE MA
02138-5502
US

V. Phone/Fax

Practice location:
  • Phone: 617-499-5151
  • Fax: 617-499-5179
Mailing address:
  • Phone: 617-673-1851
  • Fax: 617-499-5579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number123416
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: