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General NPI Number Information
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NPI Number | 1366496911
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Entity Type | Individual
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Provider Name | DERRICK JOHN MULLIN FNP
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Gender | Male
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Dates
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Enumeration Date | 05/19/2006
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Last Update Date | 11/20/2013
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Provider Practice Location Address
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Address Line | 7501 HOSPITAL DR SUITE 205
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City | SACRAMENTO
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State | CA
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Zip | 95823-5405
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Country | US
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Telephone | 916-689-2121
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Fax | 916-689-2198
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Provider Business Mailing Address
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Address Line | 7894 TIGERWOODS DR
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City | SACRAMENTO
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State | CA
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Zip | 95829-6602
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Country | US
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Telephone | 916-682-7702
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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 | 10084
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License Number State | CA
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