Provider Demographics
NPI:1720509524
Name:MULLOY, PATRICIA RAE (RN)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:RAE
Last Name:MULLOY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3719 W 155TH ST
Mailing Address - Street 2:
Mailing Address - City:MARKHAM
Mailing Address - State:IL
Mailing Address - Zip Code:60428-3812
Mailing Address - Country:US
Mailing Address - Phone:708-217-1323
Mailing Address - Fax:
Practice Address - Street 1:2635 SOMERSET DR
Practice Address - Street 2:
Practice Address - City:WESTCHESTER
Practice Address - State:IL
Practice Address - Zip Code:60154-5313
Practice Address - Country:US
Practice Address - Phone:708-531-1437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-30
Last Update Date:2017-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147201163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health