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General NPI Number Information
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NPI Number | 1629646427
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Entity Type | Individual
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Provider Name | KATHLEEN MULLANEY
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Gender | Female
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Dates
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Enumeration Date | 06/16/2021
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Last Update Date | 07/02/2025
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Provider Practice Location Address
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Address Line | 426 AIRPORT RD
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City | HAZLE TOWNSHIP
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State | PA
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Zip | 18202-3361
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Country | US
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Telephone | 570-459-9730
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Fax | 570-459-9736
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Provider Business Mailing Address
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Address Line | 100 N ACADEMY AVE
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City | DANVILLE
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State | PA
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Zip | 17822-4903
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Country | US
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Telephone | 570-459-9730
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Fax | 570-459-9736
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 347806
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | SP031519
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 347806
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 718071
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License Number State | NY
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