Healthcare Provider Details

I. General information

NPI: 1548239767
Provider Name (Legal Business Name): LAURA S MULLINS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 11/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9072 N 42ND ST
HICKORY CORNERS MI
49060-9542
US

IV. Provider business mailing address

200 N PARK ST
KALAMAZOO MI
49007-3731
US

V. Phone/Fax

Practice location:
  • Phone: 269-373-7488
  • Fax: 269-373-0123
Mailing address:
  • Phone: 269-373-7488
  • Fax: 269-373-0123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number4704084579
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: