Provider Demographics
NPI:1861829046
Name:MULLINS-SMALE, WILMA JEAN
Entity Type:Individual
Prefix:
First Name:WILMA
Middle Name:JEAN
Last Name:MULLINS-SMALE
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 1:400 W VIOLA AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-5609
Mailing Address - Country:US
Mailing Address - Phone:360-880-4089
Mailing Address - Fax:
Practice Address - Street 1:400 W VIOLA AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-5609
Practice Address - Country:US
Practice Address - Phone:360-880-4089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-02
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP00047539164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse