Provider Demographics
NPI:1205662699
Name:MULLINNEX, LISANDRA (RN)
Entity type:Individual
Prefix:
First Name:LISANDRA
Middle Name:
Last Name:MULLINNEX
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 1:341 DONELSON LN
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-9623
Mailing Address - Country:US
Mailing Address - Phone:509-949-0909
Mailing Address - Fax:
Practice Address - Street 1:151 BONLOW DR
Practice Address - Street 2:
Practice Address - City:NACHES
Practice Address - State:WA
Practice Address - Zip Code:98937-1139
Practice Address - Country:US
Practice Address - Phone:509-653-1742
Practice Address - Fax:509-653-1884
Is Sole Proprietor?:No
Enumeration Date:2024-09-11
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60282745163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool