Provider Demographics
NPI:1750073037
Name:SLM NURSE PRACTITIONER IN PSYCHIATRY PLLC
Entity type:Organization
Organization Name:SLM NURSE PRACTITIONER IN PSYCHIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:SERIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MULLEN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:646-907-3581
Mailing Address - Street 1:900 AVE AT PORT IMPERIAL BLVD APT 441
Mailing Address - Street 2:
Mailing Address - City:WEEHAWKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07086-6103
Mailing Address - Country:US
Mailing Address - Phone:646-907-3581
Mailing Address - Fax:
Practice Address - Street 1:900 AVE AT PORT IMPERIAL BLVD APT 441
Practice Address - Street 2:
Practice Address - City:WEEHAWKEN
Practice Address - State:NJ
Practice Address - Zip Code:07086-6103
Practice Address - Country:US
Practice Address - Phone:646-907-3581
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty