Provider Demographics
NPI:1497433114
Name:MULLIGAN, LAUREN ANNE
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:ANNE
Last Name:MULLIGAN
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 1:12 SANTAPOGUE CT
Mailing Address - Street 2:
Mailing Address - City:WEST BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11704-7515
Mailing Address - Country:US
Mailing Address - Phone:516-406-2763
Mailing Address - Fax:
Practice Address - Street 1:12 SANTAPOGUE CT
Practice Address - Street 2:
Practice Address - City:WEST BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11704-7515
Practice Address - Country:US
Practice Address - Phone:516-406-2763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-11
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist