Healthcare Provider Details

I. General information

NPI: 1760718209
Provider Name (Legal Business Name): CHRISTINE MARIE MULKA ANP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2009
Last Update Date: 10/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 NORTH AVE
MOUNT CLEMENS MI
48043-1716
US

IV. Provider business mailing address

215 NORTH AVE
MOUNT CLEMENS MI
48043-1716
US

V. Phone/Fax

Practice location:
  • Phone: 586-469-3750
  • Fax: 586-469-9610
Mailing address:
  • Phone: 586-469-3750
  • Fax: 586-469-9610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number4704075853
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: