Provider Demographics
NPI:1598929473
Name:MULLIN, MARY PATRICIA (DNP, FNP-BC, RN)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:PATRICIA
Last Name:MULLIN
Suffix:
Gender:F
Credentials:DNP, FNP-BC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21535 SUMMERSIDE LN
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167-1055
Mailing Address - Country:US
Mailing Address - Phone:248-444-4720
Mailing Address - Fax:
Practice Address - Street 1:250 MONROE AVE NW STE 400
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2293
Practice Address - Country:US
Practice Address - Phone:248-444-4720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704190831363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily