Provider Demographics
NPI:1346658390
Name:MULLEN, JOHN FREDERICK (FNP-C)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:FREDERICK
Last Name:MULLEN
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1181 MARSH RD
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94063-4432
Mailing Address - Country:US
Mailing Address - Phone:619-280-1967
Mailing Address - Fax:
Practice Address - Street 1:1181 MARSH RD
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-4432
Practice Address - Country:US
Practice Address - Phone:619-280-1967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-22
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95000657363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily