Provider Demographics
NPI:1457063729
Name:MULLAN, MARGUERITE KATHRYN (APN)
Entity Type:Individual
Prefix:
First Name:MARGUERITE
Middle Name:KATHRYN
Last Name:MULLAN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 CONOVER RD
Mailing Address - Street 2:
Mailing Address - City:MARLBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:07746-1003
Mailing Address - Country:US
Mailing Address - Phone:732-865-2620
Mailing Address - Fax:
Practice Address - Street 1:80 CONOVER RD
Practice Address - Street 2:
Practice Address - City:MARLBORO
Practice Address - State:NJ
Practice Address - Zip Code:07746-1003
Practice Address - Country:US
Practice Address - Phone:732-865-2620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01413200363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health