Provider Demographics
NPI:1245708353
Name:MULLEN, FELEITA DEVI (MSN, RN)
Entity type:Individual
Prefix:
First Name:FELEITA
Middle Name:DEVI
Last Name:MULLEN
Suffix:
Gender:F
Credentials:MSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 SAINT AUGUSTINE ST
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06110-1029
Mailing Address - Country:US
Mailing Address - Phone:860-983-9796
Mailing Address - Fax:
Practice Address - Street 1:304 MAIN ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-2985
Practice Address - Country:US
Practice Address - Phone:860-470-6339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-06
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT088210163W00000X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No163W00000XNursing Service ProvidersRegistered Nurse