Healthcare Provider Details

I. General information

NPI: 1093952780
Provider Name (Legal Business Name): ANGELA FAITH MCMULLEN IMM AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2009
Last Update Date: 01/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

752 WAYCROSS RD
CINCINNATI OH
45240-3184
US

IV. Provider business mailing address

752 WAYCROSS ROAD TRI-COUNTY ENT
CINCINNATI OH
45240
US

V. Phone/Fax

Practice location:
  • Phone: 513-825-5454
  • Fax: 513-825-5452
Mailing address:
  • Phone: 513-825-5454
  • Fax: 513-825-5452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberA-01398
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: