Healthcare Provider Details

I. General information

NPI: 1437409489
Provider Name (Legal Business Name): NICOLE B. F. MULLENDORE FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2012
Last Update Date: 07/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 W 7TH ST
FREDERICK MD
21701
US

IV. Provider business mailing address

PO BOX 37086
BALTIMORE MD
21297-3086
US

V. Phone/Fax

Practice location:
  • Phone: 301-698-8374
  • Fax: 240-439-8910
Mailing address:
  • Phone: 240-439-8913
  • Fax: 240-439-8910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR162044
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: