Provider Demographics
NPI:1518572403
Name:MULLINS, TAWNYA LYNN
Entity Type:Individual
Prefix:
First Name:TAWNYA
Middle Name:LYNN
Last Name:MULLINS
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 1:161 MIRACLE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:WV
Mailing Address - Zip Code:25177-1522
Mailing Address - Country:US
Mailing Address - Phone:304-444-5738
Mailing Address - Fax:
Practice Address - Street 1:161 MIRACLE DR
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:WV
Practice Address - Zip Code:25177-1522
Practice Address - Country:US
Practice Address - Phone:304-444-5738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-09
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant