Provider Demographics
NPI:1205157690
Name:MULLE, SOPHIA J
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:J
Last Name:MULLE
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 1:2508 NIANTIC DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43224-5702
Mailing Address - Country:US
Mailing Address - Phone:614-599-7203
Mailing Address - Fax:
Practice Address - Street 1:2508 NIANTIC DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43224-5702
Practice Address - Country:US
Practice Address - Phone:614-599-7203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-20
Last Update Date:2010-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH129015164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse