Provider Demographics
NPI:1407895667
Name:MCMULLEN, SUSAN CAROL (NP02/07/1966)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:CAROL
Last Name:MCMULLEN
Suffix:
Gender:F
Credentials:NP02/07/1966
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Mailing Address - Street 1:10956 DONNER PASS RD
Mailing Address - Street 2:#230
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96161-4861
Mailing Address - Country:US
Mailing Address - Phone:530-582-3277
Mailing Address - Fax:530-550-0544
Practice Address - Street 1:10956 DONNER PASS RD
Practice Address - Street 2:#230
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-4861
Practice Address - Country:US
Practice Address - Phone:530-582-3277
Practice Address - Fax:530-550-0544
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2010-12-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA11292363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP75331Medicare UPIN