Provider Demographics
NPI:1710760129
Name:MULLEN, HALEY LUWANA
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:LUWANA
Last Name:MULLEN
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 1:8670 FAIR OAKS BLVD APT 16
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-2562
Mailing Address - Country:US
Mailing Address - Phone:707-701-0812
Mailing Address - Fax:
Practice Address - Street 1:2460 CLAY BANK RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-1655
Practice Address - Country:US
Practice Address - Phone:707-701-0812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-17
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program