Healthcare Provider Details

I. General information

NPI: 1730586009
Provider Name (Legal Business Name): STEVEN MULLARKEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2014
Last Update Date: 12/14/2021
Certification Date: 12/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 FINN WAY
AVONDALE PA
19311-9354
US

IV. Provider business mailing address

520 FINN WAY
AVONDALE PA
19311-9354
US

V. Phone/Fax

Practice location:
  • Phone: 302-750-5879
  • Fax:
Mailing address:
  • Phone: 302-750-5879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberL6-0A00718
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberL1-0042417
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: