Provider Demographics
NPI:1619572823
Name:MULLIN, AMY JANE
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:JANE
Last Name:MULLIN
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 1:1100 REID PARKWAY
Mailing Address - Street 2:MEDICAL STAFF SERVICE
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1661
Mailing Address - Country:US
Mailing Address - Phone:765-935-5331
Mailing Address - Fax:
Practice Address - Street 1:1050 REID PKWY STE 300
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1155
Practice Address - Country:US
Practice Address - Phone:765-935-8941
Practice Address - Fax:765-935-8578
Is Sole Proprietor?:No
Enumeration Date:2020-12-03
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71010635A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily