Provider Demographics
NPI:1770962656
Name:MULLINS, PENNY LEE (RN)
Entity type:Individual
Prefix:
First Name:PENNY
Middle Name:LEE
Last Name:MULLINS
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 1:6536 LORRAINE DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45042-1320
Mailing Address - Country:US
Mailing Address - Phone:918-521-8402
Mailing Address - Fax:513-217-7861
Practice Address - Street 1:6536 LORRAINE DR
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45042-1320
Practice Address - Country:US
Practice Address - Phone:918-521-8402
Practice Address - Fax:513-217-7861
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-25
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN252655163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management