Provider Demographics
NPI:1851064398
Name:MULLIGAN, DANIELLE RENEE
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:RENEE
Last Name:MULLIGAN
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 1:500 SE WASHINGTON AVE.
Mailing Address - Street 2:OPTIONAL
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532
Mailing Address - Country:US
Mailing Address - Phone:253-227-3802
Mailing Address - Fax:
Practice Address - Street 1:500 SE WASHINGTON AVE.
Practice Address - Street 2:OPTIONAL
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532
Practice Address - Country:US
Practice Address - Phone:253-227-3802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-30
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP61160576164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2077844Medicaid