Provider Demographics
NPI:1083600936
Name:MULLONEY, JAMES J JR (RN, CNP)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:J
Last Name:MULLONEY
Suffix:JR
Gender:M
Credentials:RN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 BURNET AVE
Mailing Address - Street 2:ML 2004
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3026
Mailing Address - Country:US
Mailing Address - Phone:513-636-4770
Mailing Address - Fax:513-636-3847
Practice Address - Street 1:3333 BURNET AVE
Practice Address - Street 2:ML 2004
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-3026
Practice Address - Country:US
Practice Address - Phone:513-636-4770
Practice Address - Fax:513-636-3847
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH184304363LA2100X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily