Provider Demographics
NPI:1245497916
Name:MULLINS-DORAN, LISA
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:MULLINS-DORAN
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 1:1302 13TH LN
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463-4357
Mailing Address - Country:US
Mailing Address - Phone:561-868-0026
Mailing Address - Fax:
Practice Address - Street 1:1302 13TH LN
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33463-4357
Practice Address - Country:US
Practice Address - Phone:561-868-0026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-20
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No251E00000XAgenciesHome Health