Provider Demographics
NPI:1689370512
Name:MULATRE, ERICA BEVERLY
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:BEVERLY
Last Name:MULATRE
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 1:3507 GREEN BAY RD APT 112C
Mailing Address - Street 2:
Mailing Address - City:NORTH CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60064-3640
Mailing Address - Country:US
Mailing Address - Phone:260-901-9457
Mailing Address - Fax:
Practice Address - Street 1:671 S LEWIS AVE
Practice Address - Street 2:
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085-6101
Practice Address - Country:US
Practice Address - Phone:847-782-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-02
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator