Healthcare Provider Details

I. General information

NPI: 1083600936
Provider Name (Legal Business Name): JAMES J. MULLONEY JR. RN, CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 01/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE ML 2004
CINCINNATI OH
45229-3026
US

IV. Provider business mailing address

3333 BURNET AVE ML 2004
CINCINNATI OH
45229-3026
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-4770
  • Fax: 513-636-3847
Mailing address:
  • Phone: 513-636-4770
  • Fax: 513-636-3847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number184304
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number184304
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: