Provider Demographics
NPI:1174622914
Name:MULLEN, JEAN (MC)
Entity type:Individual
Prefix:DR
First Name:JEAN
Middle Name:
Last Name:MULLEN
Suffix:
Gender:F
Credentials:MC
Other - Prefix:
Other - First Name:JEAN
Other - Middle Name:
Other - Last Name:BIANCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6285 S HIGLEY RD
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85298-4262
Mailing Address - Country:US
Mailing Address - Phone:480-480-4949
Mailing Address - Fax:480-460-5858
Practice Address - Street 1:6285 S HIGLEY RD
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85298-4262
Practice Address - Country:US
Practice Address - Phone:480-480-4949
Practice Address - Fax:480-460-5858
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ30553208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
737603001OtherAPIPA
AZ0725160OtherBLUE CROSS BLUE SHIELD
1Z3150OtherHEALTHNET
AZ737603OtherAHCCCS
00023340OtherBANNER HEALTH PLAN
7376030OtherDES