Provider Demographics
NPI:1083921928
Name:MCMULLEN, ELIZABETH RAE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:RAE
Last Name:MCMULLEN
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:1115 RONALD REAGAN PKWY STE 347
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-6914
Mailing Address - Country:US
Mailing Address - Phone:317-217-2100
Mailing Address - Fax:317-217-2110
Practice Address - Street 1:1500 W OAK ST STE 500
Practice Address - Street 2:
Practice Address - City:ZIONSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46077-1852
Practice Address - Country:US
Practice Address - Phone:317-798-3708
Practice Address - Fax:317-691-8101
Is Sole Proprietor?:No
Enumeration Date:2010-09-13
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN10001214A363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant