Provider Demographics
NPI:1003895772
Name:MULL, KAREN M (CNM)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:M
Last Name:MULL
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:M
Other - Last Name:BENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2200 1ST ST
Mailing Address - Street 2:# 907
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-3400
Mailing Address - Country:US
Mailing Address - Phone:505-434-3516
Mailing Address - Fax:505-439-5705
Practice Address - Street 1:2559 MEDICAL DR
Practice Address - Street 2:SUITE D
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-8703
Practice Address - Country:US
Practice Address - Phone:505-434-2229
Practice Address - Fax:505-439-5705
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAB-097837367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA03517OtherWELLMARK
NM542OtherCNM LICENSE
NMR57355OtherRN LICENSE
IAS-64743Medicare UPIN
IAI16342Medicare ID - Type Unspecified