Provider Demographics
NPI:1780052464
Name:MULA, KELLY
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:MULA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:BOWEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 NEW SALEM RD STE 116
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401-8936
Mailing Address - Country:US
Mailing Address - Phone:724-437-0729
Mailing Address - Fax:724-437-2761
Practice Address - Street 1:766 E PITTSBURGH ST
Practice Address - Street 2:SUITE 202
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-2678
Practice Address - Country:US
Practice Address - Phone:724-437-0729
Practice Address - Fax:724-437-2761
Is Sole Proprietor?:No
Enumeration Date:2015-09-11
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN629768163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse