Provider Demographics
NPI:1487013025
Name:MULHOLLAND, TEENA NICHOLE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:TEENA
Middle Name:NICHOLE
Last Name:MULHOLLAND
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:TEENA
Other - Middle Name:NICHOLE
Other - Last Name:ROBBINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:701 E COUNTY LINE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-1072
Practice Address - Country:US
Practice Address - Phone:317-885-2860
Practice Address - Fax:317-885-2869
Is Sole Proprietor?:No
Enumeration Date:2016-02-10
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71006291A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201372930Medicaid
IN065940049Medicare PIN