Healthcare Provider Details

I. General information

NPI: 1740944743
Provider Name (Legal Business Name): DEBRA ANN MULL RN, BHSR, MBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2021
Last Update Date: 10/26/2021
Certification Date: 10/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

955 BOSCOBEL RD
ANDERSON SC
29625-6704
US

IV. Provider business mailing address

955 BOSCOBEL RD
ANDERSON SC
29625-6704
US

V. Phone/Fax

Practice location:
  • Phone: 864-332-6549
  • Fax:
Mailing address:
  • Phone: 864-332-6549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number34382
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: