Healthcare Provider Details

I. General information

NPI: 1598678864
Provider Name (Legal Business Name): RAVEN MULLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 HAMILTON DR
BUFFALO NY
14226-4748
US

IV. Provider business mailing address

145 HAMILTON DR
BUFFALO NY
14226-4748
US

V. Phone/Fax

Practice location:
  • Phone: 716-544-9975
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number353533
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: