Provider Demographics
NPI:1790343192
Name:MULLEN, SAVANAH PALEN (PA-C)
Entity Type:Individual
Prefix:
First Name:SAVANAH
Middle Name:PALEN
Last Name:MULLEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SAVANAH
Other - Middle Name:HALEY
Other - Last Name:PALEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:764 GREAT ENO PATH RD
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NC
Mailing Address - Zip Code:27278-6935
Mailing Address - Country:US
Mailing Address - Phone:407-595-9116
Mailing Address - Fax:
Practice Address - Street 1:10208 CERNY ST STE 204
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27617-7885
Practice Address - Country:US
Practice Address - Phone:919-381-5540
Practice Address - Fax:919-381-5547
Is Sole Proprietor?:No
Enumeration Date:2019-05-31
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-08947363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant