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NPI Code Detail

MEDICARE: TINA MARIE MULVENNA RN

MEDICARE: TINA MARIE MULVENNA 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
1163WH0200XHome Health Registered Nurse464706-1NY

General Provider Information

NPI Number : 1104995422
Entity Type Code : Individual
Provider Name (Legal Business Name) : TINA MARIE MULVENNA RN
Provider Business Mailing Address
First Line : 2348 N CREEK RD
Second Line :
City : LAKE VIEW
State : NY
Zip : 14085-9609
Country : US
Telephone Number : 716-627-9252
Fax Number :
Provider Business Practice Location Address
First Line : 2250 WEHRLE DR
Second Line :
City : WILLIAMSVILLE
State : NY
Zip : 14221-7037
Country : US
Telephone Number : 716-276-2123
Fax Number : 716-276-2129
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/08/2006
Last Update Date : 07/08/2007

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