MEDICARE: CONNIE MULLEN LM, CPM

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	176B00000X	Midwife	MW45	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316941891
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CONNIE MULLEN LM, CPM

Provider Business Mailing Address
First Line	:	612 NW 15TH AVE
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33486-3238
Country	:	US
Telephone Number	:	561-330-0993
Fax Number	:	561-594-1807

Provider Business Practice Location Address
First Line	:	7950 S MILITARY TRL
Second Line	:	201
City	:	LAKE WORTH
State	:	FL
Zip	:	33463-8162
Country	:	US
Telephone Number	:	561-330-0993
Fax Number	:	561-594-1807

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

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	06/06/2013

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