MEDICARE: LATRICE MULLEN

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	251G00000X	Community Based Hospice Care Agency	HSP-0001099	VA

General Provider Information

NPI Number	:	1790616761
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATRICE MULLEN

Provider Business Mailing Address
First Line	:	7420 CENTRAL BUSINESS PARK DR STE 1
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23513-2829
Country	:	US
Telephone Number	:	757-622-3010
Fax Number	:	757-622-3098

Provider Business Practice Location Address
First Line	:	7420 CENTRAL BUSINESS PARK DR STE 1
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23513-2829
Country	:	US
Telephone Number	:	757-622-3010
Fax Number	:	757-622-3098

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

Provider Enumeration Date	:	05/27/2026
Last Update Date	:	05/27/2026

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Directions to “ LATRICE MULLEN ” Practice Location

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