Provider Demographics
NPI:1578297651
Name:MULLENS, CASANDRA JUNE (PRSS)
Entity Type:Individual
Prefix:
First Name:CASANDRA
Middle Name:JUNE
Last Name:MULLENS
Suffix:
Gender:F
Credentials:PRSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1073 ARBUCKLE RD
Mailing Address - Street 2:
Mailing Address - City:SUMMERSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26651-1745
Mailing Address - Country:US
Mailing Address - Phone:304-362-0295
Mailing Address - Fax:304-883-0141
Practice Address - Street 1:1073 ARBUCKLE RD
Practice Address - Street 2:
Practice Address - City:SUMMERSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26651-1745
Practice Address - Country:US
Practice Address - Phone:304-362-0295
Practice Address - Fax:304-883-0141
Is Sole Proprietor?:No
Enumeration Date:2022-07-13
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist