Healthcare Provider Details

I. General information

NPI: 1275790461
Provider Name (Legal Business Name): AUDRINA ALEXIS MULLANE PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2008
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 W DODGE RD STE 210
OMAHA NE
68114-3321
US

IV. Provider business mailing address

PO BOX 3755
OMAHA NE
68103-0755
US

V. Phone/Fax

Practice location:
  • Phone: 402-354-3152
  • Fax: 402-354-8720
Mailing address:
  • Phone: 402-354-2100
  • Fax: 402-354-2155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number1083
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: