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General NPI Number Information
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NPI Number | 1730655820
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Entity Type | Individual
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Provider Name | TAMARA S MULLINS FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 10/16/2018
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Last Update Date | 10/16/2018
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Provider Practice Location Address
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Address Line | 5050 SKYLINE VILLAGE LOOP S
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City | SALEM
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State | OR
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Zip | 97306-9490
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Country | US
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Telephone | 503-391-1110
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Fax |
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Provider Business Mailing Address
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Address Line | 2992 AUBREY LN NE
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City | KEIZER
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State | OR
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Zip | 97303-9762
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Country | US
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Telephone | 503-851-3161
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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 | 201809056NP-PP
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License Number State | OR
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