Provider Demographics
NPI:1275790461
Name:MULLANE, AUDRINA ALEXIS (PHD)
Entity Type:Individual
Prefix:
First Name:AUDRINA
Middle Name:ALEXIS
Last Name:MULLANE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6829 N 72ND ST STE 4700
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68122-1728
Mailing Address - Country:US
Mailing Address - Phone:402-572-3749
Mailing Address - Fax:402-527-2169
Practice Address - Street 1:6829 N 72ND ST STE 4700
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68122-1728
Practice Address - Country:US
Practice Address - Phone:402-572-3749
Practice Address - Fax:402-527-2169
Is Sole Proprietor?:No
Enumeration Date:2008-05-16
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1083103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist