Provider Demographics
NPI:1740311521
Name:PAIER MULLAN, NICOLE ANNE (MD)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:ANNE
Last Name:PAIER MULLAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1443 LONG HOLLOW PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-8589
Mailing Address - Country:US
Mailing Address - Phone:615-922-8029
Mailing Address - Fax:
Practice Address - Street 1:1443 LONG HOLLOW PIKE
Practice Address - Street 2:
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-8589
Practice Address - Country:US
Practice Address - Phone:615-922-8029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN51892207R00000X
NH15230207R00000X
SCLL 291622084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH1740311521OtherANTHEM BCBS NH
NH32000651Medicaid
NH1740311521OtherTRICARE
NH1740311521OtherANTHEM BCBS NH
NH002220201Medicare PIN