Provider Demographics
NPI:1295870467
Name:MCMULLEN, SANDRA ELAINE (FNP)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:ELAINE
Last Name:MCMULLEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:SANDRA
Other - Middle Name:ELAINE
Other - Last Name:SPALLINI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:35305 PENMAN RD
Mailing Address - Street 2:AGUA DULCE
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91390-5416
Mailing Address - Country:US
Mailing Address - Phone:661-268-8668
Mailing Address - Fax:
Practice Address - Street 1:35305 PENMAN RD
Practice Address - Street 2:AGUA DULCE
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91390-5416
Practice Address - Country:US
Practice Address - Phone:661-268-8668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2009-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10240363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAV632XMedicare PIN