Healthcare Provider Details

I. General information

NPI: 1609860113
Provider Name (Legal Business Name): JEANEEN ELIZABETH MULLENHARD CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 02/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 ROBINSON RD
SEVERNA PARK MD
21146-2841
US

IV. Provider business mailing address

801 MARION QUIMBY DR
STEVENSVILLE MD
21666-2536
US

V. Phone/Fax

Practice location:
  • Phone: 410-570-9400
  • Fax:
Mailing address:
  • Phone: 410-279-6450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR084574
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: