Provider Demographics
NPI:1164829743
Name:MULLINS, KAREN L (DOM)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:L
Last Name:MULLINS
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 W ALAMEDA ST
Mailing Address - Street 2:SUITE 759
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87501-1681
Mailing Address - Country:US
Mailing Address - Phone:505-819-8454
Mailing Address - Fax:
Practice Address - Street 1:903 W ALAMEDA ST
Practice Address - Street 2:SUITE 759
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501-1681
Practice Address - Country:US
Practice Address - Phone:505-819-8454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-26
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1152171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist