Healthcare Provider Details

I. General information

NPI: 1023807419
Provider Name (Legal Business Name): DIANA LYNN MULLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2025
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 BARBARA LOOP SE STE A
RIO RANCHO NM
87124-1011
US

IV. Provider business mailing address

9611 PALOMITA CT NW
ALBUQUERQUE NM
87114-3486
US

V. Phone/Fax

Practice location:
  • Phone: 505-900-4029
  • Fax:
Mailing address:
  • Phone: 505-977-2450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: