Provider Demographics
NPI:1245777382
Name:MULLEN, ALISE (RN)
Entity Type:Individual
Prefix:MRS
First Name:ALISE
Middle Name:
Last Name:MULLEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:CAROLYN ALISE
Other - Middle Name:
Other - Last Name:MULLEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:1806 W. CENTRE AVE
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:NM
Mailing Address - Zip Code:88210
Mailing Address - Country:US
Mailing Address - Phone:575-748-2755
Mailing Address - Fax:575-748-2334
Practice Address - Street 1:1806 W. CENTRE AVE
Practice Address - Street 2:
Practice Address - City:ARTESIA
Practice Address - State:NM
Practice Address - Zip Code:88210
Practice Address - Country:US
Practice Address - Phone:575-748-2755
Practice Address - Fax:575-748-2334
Is Sole Proprietor?:No
Enumeration Date:2017-01-27
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR54996163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool