Provider Demographics
NPI:1548760127
Name:MULLEN, WILLA PAULINE
Entity Type:Individual
Prefix:
First Name:WILLA
Middle Name:PAULINE
Last Name:MULLEN
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 1:599 TEXAS PARK
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77302-2005
Mailing Address - Country:US
Mailing Address - Phone:570-506-4379
Mailing Address - Fax:
Practice Address - Street 1:599 TEXAS PARK
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77302-2005
Practice Address - Country:US
Practice Address - Phone:570-506-4379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-20
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX142306164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse