Healthcare Provider Details

I. General information

NPI: 1821502105
Provider Name (Legal Business Name): KAITLIN MULLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2017
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 MOUNTAINVIEW BLVD
BASKING RIDGE NJ
07920-3444
US

IV. Provider business mailing address

68 DEER CREEK DR
BASKING RIDGE NJ
07920-2682
US

V. Phone/Fax

Practice location:
  • Phone: 646-608-8041
  • Fax:
Mailing address:
  • Phone: 908-642-6853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26NJ01157000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number26NR16219700
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number308585
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number664433
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: