Provider Demographics
NPI:1417611542
Name:MULLIN, DANIELLE ANN
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:ANN
Last Name:MULLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15782 HUNTERS RUN
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040-9658
Mailing Address - Country:US
Mailing Address - Phone:937-243-7012
Mailing Address - Fax:
Practice Address - Street 1:15782 HUNTERS RUN
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-9658
Practice Address - Country:US
Practice Address - Phone:937-243-7012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-25
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1102845OtherCONTRACT NUMBER