Provider Demographics
NPI:1750995783
Name:MULLINS, STEPHANIE N
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:N
Last Name:MULLINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 441
Mailing Address - Street 2:
Mailing Address - City:MAC ARTHUR
Mailing Address - State:WV
Mailing Address - Zip Code:25873-0441
Mailing Address - Country:US
Mailing Address - Phone:304-923-0939
Mailing Address - Fax:
Practice Address - Street 1:217 LURAY ST
Practice Address - Street 2:
Practice Address - City:MACARTHUR
Practice Address - State:WV
Practice Address - Zip Code:25873
Practice Address - Country:US
Practice Address - Phone:304-923-0939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant