Provider Demographics
NPI:1063832749
Name:MULDER, PATRICIA CHU (PA)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:CHU
Last Name:MULDER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2639 MORGAN LAKE DR NE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-5611
Mailing Address - Country:US
Mailing Address - Phone:786-925-7385
Mailing Address - Fax:
Practice Address - Street 1:2639 MORGAN LAKE DR NE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-5611
Practice Address - Country:US
Practice Address - Phone:786-925-7385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-22
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant