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NPI Code Detail

MEDICARE: LISA MARIE MULLEN MD

MEDICARE: LISA MARIE MULLEN MD
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
1207Q00000XFamily Medicine PhysicianMR-1172ID
2207Q00000XFamily Medicine Physician9778AWY

General Provider Information

NPI Number : 1629364377
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA MARIE MULLEN MD
Provider Business Mailing Address
First Line : 497 W LOTT ST
Second Line :
City : BUFFALO
State : WY
Zip : 82834-1658
Country : US
Telephone Number : 307-684-2228
Fax Number : 307-684-2177
Provider Business Practice Location Address
First Line : 497 W LOTT ST
Second Line :
City : BUFFALO
State : WY
Zip : 82834-1658
Country : US
Telephone Number : 307-684-2228
Fax Number : 307-684-2177
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/21/2011
Last Update Date : 02/16/2015

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Directions to “ LISA MARIE MULLEN MD” Practice Location

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