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General NPI Number Information
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NPI Number | 1982217824
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Entity Type | Individual
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Provider Name | BRIANNA MULQUEEN
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Gender | Female
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Dates
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Enumeration Date | 08/29/2020
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Last Update Date | 08/12/2021
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Provider Practice Location Address
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Address Line | 35 WOODPECKER LN
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City | LEVITTOWN
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State | NY
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Zip | 11756-3212
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Country | US
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Telephone | 516-521-3687
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Fax |
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Provider Business Mailing Address
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Address Line | 1 HEALTHY WAY
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City | OCEANSIDE
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State | NY
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Zip | 11572-1551
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Country | US
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Telephone | 516-521-3687
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 026243
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License Number State | NY
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