Provider Demographics
NPI:1003339987
Name:MULLEN, MARISA TAILOR
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:TAILOR
Last Name:MULLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3245 CLOVER WAY # 4-313
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-4786
Mailing Address - Country:US
Mailing Address - Phone:530-300-3898
Mailing Address - Fax:
Practice Address - Street 1:502 SILVERSMITH PL
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-8148
Practice Address - Country:US
Practice Address - Phone:530-300-3898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-21
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider