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NPI Code Detail

MEDICARE: MARILYN KAY MULLANE PA-C

MEDICARE: MARILYN KAY MULLANE PA-C
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
1363AM0700XMedical Physician Assistant101138NC
2363A00000XPhysician Assistant101138NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1821091547
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARILYN KAY MULLANE PA-C
Provider Business Mailing Address
First Line : PO BOX 751803
Second Line :
City : CHARLOTTE
State : NC
Zip : 28275-1803
Country : US
Telephone Number : 336-766-0547
Fax Number : 336-766-0549
Provider Business Practice Location Address
First Line : 390 W SALEM AVE
Second Line :
City : WINSTON SALEM
State : NC
Zip : 27101-5861
Country : US
Telephone Number : 336-721-2375
Fax Number : 336-721-2394
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/27/2005
Last Update Date : 01/03/2019

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Directions to “ MARILYN KAY MULLANE PA-C” Practice Location

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