Provider Demographics
NPI:1063452209
Name:MULLEN, CATHERINE GLAUBER (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:GLAUBER
Last Name:MULLEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 17969
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27715-7969
Mailing Address - Country:US
Mailing Address - Phone:919-668-8088
Mailing Address - Fax:919-668-7026
Practice Address - Street 1:2400 PRATT STREET
Practice Address - Street 2:0311 TERRACE LEVEL
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-7969
Practice Address - Country:US
Practice Address - Phone:919-668-8088
Practice Address - Fax:919-668-7026
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110001213363AM0700X
NC363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0110001213OtherSTATE LICENSE
OOB192M91Medicare ID - Type Unspecified