Healthcare Provider Details

I. General information

NPI: 1982175337
Provider Name (Legal Business Name): PAULA J MULLINS CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2018
Last Update Date: 09/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 NILES CORTLAND RD NE
WARREN OH
44484-1977
US

IV. Provider business mailing address

311 NILES CORTLAND RD NE
WARREN OH
44484-1977
US

V. Phone/Fax

Practice location:
  • Phone: 330-393-3376
  • Fax: 330-394-3376
Mailing address:
  • Phone: 330-393-3376
  • Fax: 330-394-3376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR234804
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.025359
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: