Provider Demographics
NPI:1629029459
Name:HADDIGAN-MULBERRY, MOLLIE (NP)
Entity Type:Individual
Prefix:MS
First Name:MOLLIE
Middle Name:
Last Name:HADDIGAN-MULBERRY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9000 W WISCONSIN AVE
Mailing Address - Street 2:PEDIATRIC HEMATOLOGY/ONCOLOGY/BONE MARROW TRANSPLANT
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4874
Mailing Address - Country:US
Mailing Address - Phone:414-456-4170
Mailing Address - Fax:414-456-6543
Practice Address - Street 1:9000 W WISCONSIN AVE
Practice Address - Street 2:PEDIATRIC HEMATOLOGY/ONCOLOGY/BONE MARROW TRANSPLANT
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-4874
Practice Address - Country:US
Practice Address - Phone:414-456-4170
Practice Address - Fax:414-456-6543
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI131888363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
001856332FOtherHUMANA
WI1629029459Medicaid
WI021R 73-601Medicare PIN
WI1629029459Medicaid