Provider Demographics
NPI:1851946339
Name:MULHOLLAND, JEANNETTE LILLIAN
Entity Type:Individual
Prefix:
First Name:JEANNETTE
Middle Name:LILLIAN
Last Name:MULHOLLAND
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 1:6256 BRYCE CANYON AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89156-5812
Mailing Address - Country:US
Mailing Address - Phone:702-807-5319
Mailing Address - Fax:
Practice Address - Street 1:6256 BRYCE CANYON AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89156-5812
Practice Address - Country:US
Practice Address - Phone:702-807-5319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-02
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider