Provider Demographics
NPI:1417300013
Name:MULDER, ALLISON (CVS)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:MULDER
Suffix:
Gender:F
Credentials:CVS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 E 15TH AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:GULF SHORES
Mailing Address - State:AL
Mailing Address - Zip Code:36542-3516
Mailing Address - Country:US
Mailing Address - Phone:251-948-0065
Mailing Address - Fax:
Practice Address - Street 1:156 E 15TH AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:GULF SHORES
Practice Address - State:AL
Practice Address - Zip Code:36542-3516
Practice Address - Country:US
Practice Address - Phone:251-948-0065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-19
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography