Provider Demographics
NPI:1629642434
Name:MULLIGAN, SHANTA (RN DNPC)
Entity Type:Individual
Prefix:
First Name:SHANTA
Middle Name:
Last Name:MULLIGAN
Suffix:
Gender:F
Credentials:RN DNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 THREADLEAF TER
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08016-4349
Mailing Address - Country:US
Mailing Address - Phone:609-612-9467
Mailing Address - Fax:
Practice Address - Street 1:33 THREADLEAF TER
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08016-4349
Practice Address - Country:US
Practice Address - Phone:609-612-9467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-17
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY557602-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse