Provider Demographics
NPI:1417374927
Name:MULLOOLY, CAROLYN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:
Last Name:MULLOOLY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 PEPPERTREE DR
Mailing Address - Street 2:
Mailing Address - City:NEW KENSINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15068-8309
Mailing Address - Country:US
Mailing Address - Phone:412-793-1918
Mailing Address - Fax:
Practice Address - Street 1:301 MEADE ST
Practice Address - Street 2:
Practice Address - City:WILKINSBURG
Practice Address - State:PA
Practice Address - Zip Code:15221-2131
Practice Address - Country:US
Practice Address - Phone:412-436-1298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-21
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN270029164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse