Healthcare Provider Details

I. General information

NPI: 1790616761
Provider Name (Legal Business Name): LATRICE MULLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7420 CENTRAL BUSINESS PARK DR STE 1
NORFOLK VA
23513-2829
US

IV. Provider business mailing address

7420 CENTRAL BUSINESS PARK DR STE 1
NORFOLK VA
23513-2829
US

V. Phone/Fax

Practice location:
  • Phone: 757-622-3010
  • Fax: 757-622-3098
Mailing address:
  • Phone: 757-622-3010
  • Fax: 757-622-3098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License NumberHSP-0001099
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: