Provider Demographics
NPI:1497846349
Name:MULLEN, PATRICIA LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:LYNN
Last Name:MULLEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 40
Mailing Address - Street 2:
Mailing Address - City:PAHALA
Mailing Address - State:HI
Mailing Address - Zip Code:96777-0040
Mailing Address - Country:US
Mailing Address - Phone:808-932-4200
Mailing Address - Fax:808-928-8980
Practice Address - Street 1:1 KAMANI ST
Practice Address - Street 2:
Practice Address - City:PAHALA
Practice Address - State:HI
Practice Address - Zip Code:96777
Practice Address - Country:US
Practice Address - Phone:808-932-4200
Practice Address - Fax:808-928-8980
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI15423207Q00000X
CAG49523207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine