Healthcare Provider Details

I. General information

NPI: 1790343192
Provider Name (Legal Business Name): SAVANAH PALEN MULLEN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SAVANAH HALEY PALEN

II. Dates (important events)

Enumeration Date: 05/31/2019
Last Update Date: 05/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10208 CERNY ST STE 204
RALEIGH NC
27617-7885
US

IV. Provider business mailing address

764 GREAT ENO PATH RD
HILLSBOROUGH NC
27278-6935
US

V. Phone/Fax

Practice location:
  • Phone: 919-381-5540
  • Fax: 919-381-5547
Mailing address:
  • Phone: 407-595-9116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-08947
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: