Provider Demographics
NPI:1245912542
Name:MULLIKIN, SUZANNE GREEN (APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:GREEN
Last Name:MULLIKIN
Suffix:
Gender:
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 SHALLOWFORD RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-3312
Mailing Address - Country:US
Mailing Address - Phone:803-468-2632
Mailing Address - Fax:
Practice Address - Street 1:52 BEAR DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4458
Practice Address - Country:US
Practice Address - Phone:864-655-4005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-04
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC27719363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily