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General NPI Number Information
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NPI Number | 1275742173
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Entity Type | Organization
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Legal Business Name | DANETTE R. ELLIOTT-MULLENS, DO, PA
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Dates
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Enumeration Date | 05/21/2007
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Last Update Date | 03/10/2010
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Provider Practice Location Address
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Address Line | 2660 E. COMMON ST. STE #201
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City | NEW BRAUNFELS
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State | TX
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Zip | 78130-3168
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Country | US
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Telephone | 830-627-3385
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Fax | 830-620-0294
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Provider Business Mailing Address
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Address Line | 2660 E. COMMON ST. STE. #201
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City | NEW BRAUNFELS
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State | TX
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Zip | 78130-3168
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Country | US
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Telephone | 830-627-3385
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Fax | 830-620-0294
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. DANETTE RAI ELLIOTT-MULLENS
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Credential | DO
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Telephone | 830-627-3385
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | K9775
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | K9775
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License Number State | TX
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