Provider Demographics
NPI:1437692605
Name:MULIG, AMANDA PAIGE (NP)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:PAIGE
Last Name:MULIG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:PAIGE
Other - Last Name:MULIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 122342
Mailing Address - Street 2:DEPT 2342
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75312-2342
Mailing Address - Country:US
Mailing Address - Phone:337-494-4868
Mailing Address - Fax:337-494-4870
Practice Address - Street 1:2770 3RD AVE
Practice Address - Street 2:STE 120
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-8994
Practice Address - Country:US
Practice Address - Phone:337-494-4868
Practice Address - Fax:337-494-4870
Is Sole Proprietor?:No
Enumeration Date:2016-11-21
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP08935363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily