Provider Demographics
NPI:1518989375
Name:MULLIGAN, CHRISTINE (PMHCNS-BC,CRNP)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:MULLIGAN
Suffix:
Gender:F
Credentials:PMHCNS-BC,CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 OLD WEST CHESTER PIKE
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-2712
Mailing Address - Country:US
Mailing Address - Phone:610-710-5132
Mailing Address - Fax:610-449-3969
Practice Address - Street 1:202 N FAIRFIELD RD
Practice Address - Street 2:
Practice Address - City:DEVON
Practice Address - State:PA
Practice Address - Zip Code:19333-1422
Practice Address - Country:US
Practice Address - Phone:610-710-5132
Practice Address - Fax:484-454-8700
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN298349L163WP0808X
PASP010559364SP0808X
PASP011645363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA582305Medicare PIN