MEDICARE: MRS. SHERRY THOMAS MULLENIX JD, RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	34337	AL

General Provider Information

NPI Number	:	1104042571
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHERRY THOMAS MULLENIX JD, RN

Provider Business Mailing Address
First Line	:	PO BOX 847
Second Line	:
City	:	GARDENDALE
State	:	AL
Zip	:	35071-0847
Country	:	US
Telephone Number	:	205-631-1201
Fax Number	:	205-608-1596

Provider Business Practice Location Address
First Line	:	2660 MOUNT OLIVE RD
Second Line	:
City	:	MOUNT OLIVE
State	:	AL
Zip	:	35117-3925
Country	:	US
Telephone Number	:	205-631-1201
Fax Number	:	205-608-1596

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	07/08/2007

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