Provider Demographics
NPI:1801413653
Name:MULL, ALEXANDRA CAITLIN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:ALEXANDRA
Middle Name:CAITLIN
Last Name:MULL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2929 N 70TH ST APT 2050
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-6351
Mailing Address - Country:US
Mailing Address - Phone:724-961-2133
Mailing Address - Fax:
Practice Address - Street 1:2929 N 70TH ST APT 2050
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-6351
Practice Address - Country:US
Practice Address - Phone:724-961-2133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-28
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AZ8137363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program