Provider Demographics
NPI:1558867606
Name:MULLINS, LENEA RAE (NP NURSE PRACTITIONE)
Entity Type:Individual
Prefix:MRS
First Name:LENEA
Middle Name:RAE
Last Name:MULLINS
Suffix:
Gender:F
Credentials:NP NURSE PRACTITIONE
Other - Prefix:MRS
Other - First Name:LENEA
Other - Middle Name:RAE
Other - Last Name:HARDIMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3549 LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48329-2282
Mailing Address - Country:US
Mailing Address - Phone:248-469-6093
Mailing Address - Fax:
Practice Address - Street 1:3549 LAKESHORE DR
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48329-2282
Practice Address - Country:US
Practice Address - Phone:248-469-6093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-05
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704230460163W00000X, 363LA2200X, 363LP2300X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163W00000XNursing Service ProvidersRegistered Nurse
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
163W00000XOtherTAXONOMY