MEDICARE: MR. SCOTT ALLEN MULDER FNP

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	363LF0000X	Family Nurse Practitioner	735242	TX

General Provider Information

NPI Number	:	1518209501
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SCOTT ALLEN MULDER FNP

Provider Business Mailing Address
First Line	:	3415 CRYSTAL DOVE DR
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77388-9355
Country	:	US
Telephone Number	:	832-387-0171
Fax Number	:

Provider Business Practice Location Address
First Line	:	2502 CANAL ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77003-1523
Country	:	US
Telephone Number	:	713-224-0555
Fax Number	:

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

Provider Enumeration Date	:	03/18/2013
Last Update Date	:	03/18/2013

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