Provider Demographics
NPI:1366005340
Name:MULLIGAN, LAURA ELAINE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:ELAINE
Last Name:MULLIGAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2052 AVENUE 396
Mailing Address - Street 2:
Mailing Address - City:KINGSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:93631-9125
Mailing Address - Country:US
Mailing Address - Phone:559-593-5015
Mailing Address - Fax:
Practice Address - Street 1:2052 AVENUE 396
Practice Address - Street 2:
Practice Address - City:KINGSBURG
Practice Address - State:CA
Practice Address - Zip Code:93631-9125
Practice Address - Country:US
Practice Address - Phone:559-593-5015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-16
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95011617207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine