Provider Demographics
NPI:1982844692
Name:MULKERIN, PATRICK O (NP-C)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:O
Last Name:MULKERIN
Suffix:
Gender:M
Credentials:NP-C
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2249 WEALTHY ST SE
Mailing Address - Street 2:STE 202
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-3052
Mailing Address - Country:US
Mailing Address - Phone:248-952-1601
Mailing Address - Fax:248-952-1614
Practice Address - Street 1:1787 GRAND RIDGE CT NE
Practice Address - Street 2:STE 202
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-7042
Practice Address - Country:US
Practice Address - Phone:616-808-2695
Practice Address - Fax:616-808-2697
Is Sole Proprietor?:No
Enumeration Date:2009-02-20
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704176703363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner