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General NPI Number Information
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NPI Number | 1467059956
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Entity Type | Individual
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Provider Name | KORENA L MULLOY
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Gender | Female
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Dates
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Enumeration Date | 10/07/2020
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Last Update Date | 10/07/2020
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Provider Practice Location Address
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Address Line | 6847 N CHESTNUT ST
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City | RAVENNA
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State | OH
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Zip | 44266-3929
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Country | US
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Telephone | 856-439-6111
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Fax |
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Provider Business Mailing Address
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Address Line | 4700 HEWITT GIFFORD RD SW
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City | WARREN
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State | OH
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Zip | 44481-9157
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Country | US
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Telephone | 330-931-6108
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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 | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | LPN.172388
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License Number State | OH
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