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General NPI Number Information
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NPI Number | 1912550468
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Entity Type | Individual
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Provider Name | MARY R. MULLINS DNP
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Gender | Female
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Dates
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Enumeration Date | 07/23/2019
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Last Update Date | 03/07/2025
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Provider Practice Location Address
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Address Line | 211 E HARPOLE ST
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City | WILLIAMSVILLE
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State | IL
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Zip | 62693-9718
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Country | US
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Telephone | 175-889-8712
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 103
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City | WILLIAMSVILLE
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State | IL
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Zip | 62693-0103
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 209019659
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License Number State | IL
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