Provider Demographics
NPI:1851165351
Name:MAULSBY, MANDI LEANNE
Entity Type:Individual
Prefix:
First Name:MANDI
Middle Name:LEANNE
Last Name:MAULSBY
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 1:5813 E 18TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74112-7103
Mailing Address - Country:US
Mailing Address - Phone:918-813-7845
Mailing Address - Fax:
Practice Address - Street 1:5813 E 18TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74112-7103
Practice Address - Country:US
Practice Address - Phone:918-813-7845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist