Provider Demographics
NPI:1568048619
Name:MULLENS, RUTH
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:
Last Name:MULLENS
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:PO BOX 271
Mailing Address - Street 2:
Mailing Address - City:MOUNT LOOKOUT
Mailing Address - State:WV
Mailing Address - Zip Code:26678-0271
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:74 NEVADA STREET
Practice Address - Street 2:
Practice Address - City:CANVAS
Practice Address - State:WV
Practice Address - Zip Code:26667
Practice Address - Country:US
Practice Address - Phone:304-872-0548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-19
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker