MEDICARE: KIANA LASHAY MULLINS LPN

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	332B00000X	Durable Medical Equipment & Medical Supplies
2	164W00000X	Licensed Practical Nurse	184206	OH

General Provider Information

NPI Number	:	1396535159
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIANA LASHAY MULLINS LPN

Provider Business Mailing Address
First Line	:	5616 BIRCHDALE DR
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43623-1906
Country	:	US
Telephone Number	:	419-213-0957
Fax Number	:

Provider Business Practice Location Address
First Line	:	5616 BIRCHDALE DR
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43623-1906
Country	:	US
Telephone Number	:	419-213-0957
Fax Number	:

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

Provider Enumeration Date	:	05/07/2025
Last Update Date	:	05/14/2025

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