Provider Demographics
NPI:1710586557
Name:MULLINS, DONNA ANN
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:ANN
Last Name:MULLINS
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 1:28 TRACEY LN
Mailing Address - Street 2:
Mailing Address - City:MOUNDSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26041-4174
Mailing Address - Country:US
Mailing Address - Phone:304-845-9761
Mailing Address - Fax:
Practice Address - Street 1:28 TRACEY LN
Practice Address - Street 2:
Practice Address - City:MOUNDSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26041-4174
Practice Address - Country:US
Practice Address - Phone:304-845-9761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant