Provider Demographics
NPI:1093900466
Name:MULLINS, DIANE LANCASTER (PA)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:LANCASTER
Last Name:MULLINS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1798
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27533-1798
Mailing Address - Country:US
Mailing Address - Phone:919-739-8266
Mailing Address - Fax:919-739-8656
Practice Address - Street 1:901 BEECH ST
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-2922
Practice Address - Country:US
Practice Address - Phone:919-739-8266
Practice Address - Fax:919-739-8656
Is Sole Proprietor?:No
Enumeration Date:2007-09-10
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC100206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant