Provider Demographics
NPI:1861855744
Name:MULLEN, VALERIE MARIE (RN)
Entity Type:Individual
Prefix:MRS
First Name:VALERIE
Middle Name:MARIE
Last Name:MULLEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 266
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62442-0266
Mailing Address - Country:US
Mailing Address - Phone:217-382-4207
Mailing Address - Fax:217-382-4226
Practice Address - Street 1:997 N. YORK ST.
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62442-0266
Practice Address - Country:US
Practice Address - Phone:217-382-4207
Practice Address - Fax:217-382-4226
Is Sole Proprietor?:No
Enumeration Date:2016-03-30
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041335621163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health