Provider Demographics
NPI:1093005415
Name:WHYTE-MULLINGS, SUSAN (LPN)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:WHYTE-MULLINGS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4378 EDSON AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-1814
Mailing Address - Country:US
Mailing Address - Phone:347-249-3580
Mailing Address - Fax:
Practice Address - Street 1:4378 EDSON AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-1814
Practice Address - Country:US
Practice Address - Phone:347-249-3580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-19
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY305154164W00000X
NY712405163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse