Provider Demographics
NPI:1851600621
Name:HAVRILLA, MAUREEN MULLIKIN (RN, MSN, CPNP)
Entity Type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:MULLIKIN
Last Name:HAVRILLA
Suffix:
Gender:F
Credentials:RN, MSN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 FOREST TRL
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-3481
Mailing Address - Country:US
Mailing Address - Phone:512-219-6686
Mailing Address - Fax:
Practice Address - Street 1:7700 CAT HOLLOW DR
Practice Address - Street 2:SUITE 104
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-5796
Practice Address - Country:US
Practice Address - Phone:512-733-5437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-28
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX458454363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics