Provider Demographics
NPI:1790051126
Name:MULLINAX, ANA ALYSE (LVN)
Entity Type:Individual
Prefix:MRS
First Name:ANA
Middle Name:ALYSE
Last Name:MULLINAX
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:ANA
Other - Middle Name:ALYSE
Other - Last Name:STEPHANCHICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2170 TRAWOOD DR
Mailing Address - Street 2:APT 101
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79935-3375
Mailing Address - Country:US
Mailing Address - Phone:440-242-1011
Mailing Address - Fax:
Practice Address - Street 1:2170 TRAWOOD DR
Practice Address - Street 2:APT 101
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79935-3375
Practice Address - Country:US
Practice Address - Phone:440-242-1011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-29
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX301284164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse