MEDICARE: JESSICA I 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	103TR0400X	Rehabilitation Psychologist

General Provider Information

NPI Number	:	1811298607
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA I MULLEN

Provider Business Mailing Address
First Line	:	2611 BARBARADALE CIR
Second Line	:	N/A
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-5160
Country	:	US
Telephone Number	:	702-418-2946
Fax Number	:

Provider Business Practice Location Address
First Line	:	2611 BARBARADALE CIR
Second Line	:	N/A
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-5160
Country	:	US
Telephone Number	:	702-418-2946
Fax Number	:

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

Provider Enumeration Date	:	11/09/2010
Last Update Date	:	11/09/2010

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Directions to “ JESSICA I MULLEN ” Practice Location

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