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General NPI Number Information
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NPI Number | 1063744456
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Entity Type | Individual
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Provider Name | MENDY L MULLIS C-PA
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Gender | Female
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Dates
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Enumeration Date | 02/10/2010
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Last Update Date | 06/23/2023
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Provider Practice Location Address
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Address Line | 202 N WEST ST
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City | ODON
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State | IN
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Zip | 47562-1032
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Country | US
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Telephone | 812-636-7300
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Fax | 812-257-7073
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Provider Business Mailing Address
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Address Line | PO BOX 760
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City | WASHINGTON
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State | IN
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Zip | 47501-0760
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Country | US
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Telephone | 812-254-2760
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Fax | 812-254-8636
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 10001157A
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License Number State | IN
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