Healthcare Provider Details

I. General information

NPI: 1518371558
Provider Name (Legal Business Name): LAURA R MULLEN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2014
Last Update Date: 12/08/2021
Certification Date: 12/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 FOUNDRY ST STE 201
CONCORD NH
03301-5421
US

IV. Provider business mailing address

18 FOUNDRY ST STE 201
CONCORD NH
03301-5421
US

V. Phone/Fax

Practice location:
  • Phone: 603-228-0071
  • Fax: 603-227-7535
Mailing address:
  • Phone: 603-228-0071
  • Fax: 603-227-7535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number054925-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: