Provider Demographics
NPI:1801409818
Name:MULLEN, GABRIELLE BEVERLY (LVN)
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:BEVERLY
Last Name:MULLEN
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 RANDY DR
Mailing Address - Street 2:
Mailing Address - City:WOODWAY
Mailing Address - State:TX
Mailing Address - Zip Code:76712-9783
Mailing Address - Country:US
Mailing Address - Phone:254-248-2109
Mailing Address - Fax:
Practice Address - Street 1:304 RANDY DR
Practice Address - Street 2:
Practice Address - City:WOODWAY
Practice Address - State:TX
Practice Address - Zip Code:76712-9783
Practice Address - Country:US
Practice Address - Phone:254-248-2109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1007796164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse