Healthcare Provider Details

I. General information

NPI: 1154805349
Provider Name (Legal Business Name): JO DEE MULHOLLAN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2018
Last Update Date: 11/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 S MAIN ST
DU BOIS PA
15801-1413
US

IV. Provider business mailing address

100 HOSPITAL AVE
DU BOIS PA
15801-1440
US

V. Phone/Fax

Practice location:
  • Phone: 814-299-7520
  • Fax: 814-375-7798
Mailing address:
  • Phone: 814-299-7520
  • Fax: 814-375-7798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP019168
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: