Provider Demographics
NPI:1114526860
Name:MULLEN, JENNIFFER L (PHD, RN, CHPN, CNE)
Entity Type:Individual
Prefix:DR
First Name:JENNIFFER
Middle Name:L
Last Name:MULLEN
Suffix:
Gender:F
Credentials:PHD, RN, CHPN, CNE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3675 PINE HILL RD
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:NY
Mailing Address - Zip Code:14830-9742
Mailing Address - Country:US
Mailing Address - Phone:607-425-5534
Mailing Address - Fax:
Practice Address - Street 1:3675 PINE HILL RD
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:NY
Practice Address - Zip Code:14830-9742
Practice Address - Country:US
Practice Address - Phone:607-425-5534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-23
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY588811163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse