=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821322421
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TERIA MULLIN APN, CRNA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/29/2009
-----------------------------------------------------
Last Update Date | 12/12/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2540 N GALLOWAY AVE STE 303
-----------------------------------------------------
City | MESQUITE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75150-4814
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-779-0007
-----------------------------------------------------
Fax | 513-987-9512
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5606 SMU BLVD PO BOX 602002
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75206-9998
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-699-6688
-----------------------------------------------------
Fax | 513-987-9512
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 041.337943
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 367500000X
-----------------------------------------------------
Taxonomy Name | Certified Registered Nurse Anesthetist
-----------------------------------------------------
License Number | 209007935
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------