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General NPI Number Information
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NPI Number | 1376955633
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Entity Type | Individual
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Provider Name | COLLIN MULDER
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Gender | Male
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Dates
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Enumeration Date | 05/21/2014
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Last Update Date | 05/21/2014
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Provider Practice Location Address
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Address Line | 14108 OLD DIXIE HWY
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City | HUDSON
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State | FL
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Zip | 34667-1362
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Country | US
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Telephone | 616-240-3016
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Fax |
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Provider Business Mailing Address
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Address Line | 14108 OLD DIXIE HWY
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City | HUDSON
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State | FL
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Zip | 34667-1362
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Country | US
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Telephone |
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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 | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 9047
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License Number State | FL
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