Basic Information
| Provider Information | |||||||||
| NPI: | 1033867957 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MULLIN | ||||||||
| FirstName: | KENDRA | ||||||||
| MiddleName: | NICOLE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 723 SW 10TH ST | ||||||||
| Address2: | |||||||||
| City: | RENTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980575223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2068875945 | ||||||||
| FaxNumber: | 2064616989 | ||||||||
| Practice Location | |||||||||
| Address1: | 723 SW 10TH ST | ||||||||
| Address2: | |||||||||
| City: | RENTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980575223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2068875945 | ||||||||
| FaxNumber: | 2064616989 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/10/2022 | ||||||||
| LastUpdateDate: | 03/10/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 247000000X | Y | Technologists, Technicians & Other Technical Service Providers | Technician, Health Information |
No ID Information.