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General NPI Number Information
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NPI Number | 1063978484
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Entity Type | Individual
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Provider Name | CHARLENE D MCMULLIN NP
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Gender | Female
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Dates
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Enumeration Date | 02/11/2019
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Last Update Date | 02/11/2019
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Provider Practice Location Address
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Address Line | 200 WALLACE DRIVE EASTERLING CORRECTIONAL FACILITY (WEXFORD HEALTH)
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City | CLIO
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State | AL
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Zip | 36017
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Country | US
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Telephone | 334-397-4470
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Fax |
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Provider Business Mailing Address
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Address Line | 99 COUNTY ROAD 50
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City | TUSKEGEE
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State | AL
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Zip | 36083-5537
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Country | US
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Telephone | 334-727-4917
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1-134373
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License Number State | AL
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