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General NPI Number Information
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NPI Number | 1043970494
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Entity Type | Individual
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Provider Name | BRANDY L MULLETT APRN
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Gender | Female
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Dates
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Enumeration Date | 12/27/2021
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Last Update Date | 01/16/2025
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Provider Practice Location Address
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Address Line | 3535 PENTAGON BLVD # 1157
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City | BEAVERCREEK
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State | OH
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Zip | 45431-1705
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Country | US
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Telephone | 937-702-4450
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Fax | 937-702-4459
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Provider Business Mailing Address
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Address Line | 30 E APPLE ST STE 5254A
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City | DAYTON
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State | OH
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Zip | 45409-2939
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Country | US
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Telephone | 937-208-4200
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | APRN.CNP.0029619
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License Number State | OH
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