Provider Demographics
NPI:1225067077
Name:MULLEN, LOANNE M (PA-C)
Entity Type:Individual
Prefix:
First Name:LOANNE
Middle Name:M
Last Name:MULLEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3838 SAN DIMAS ST
Mailing Address - Street 2:SUITE B-100
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-2284
Mailing Address - Country:US
Mailing Address - Phone:661-326-0088
Mailing Address - Fax:661-861-0214
Practice Address - Street 1:3838 SAN DIMAS ST
Practice Address - Street 2:SUITE B-100
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-2284
Practice Address - Country:US
Practice Address - Phone:661-326-0088
Practice Address - Fax:661-861-0214
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA13977363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPA139771Medicare PIN