Provider Demographics
NPI:1942434733
Name:MULLINS, STACY L (CNA)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:L
Last Name:MULLINS
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3441 W WARREN DR
Mailing Address - Street 2:APT 4
Mailing Address - City:WARSAW
Mailing Address - State:IN
Mailing Address - Zip Code:46580-8340
Mailing Address - Country:US
Mailing Address - Phone:574-306-2818
Mailing Address - Fax:
Practice Address - Street 1:3441 W WARREN DR
Practice Address - Street 2:APT 4
Practice Address - City:WARSAW
Practice Address - State:IN
Practice Address - Zip Code:46580-8340
Practice Address - Country:US
Practice Address - Phone:574-306-2818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-07
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INCNA0204809376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide