Basic Information
| Provider Information | |||||||||
| NPI: | 1164995080 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MULL | ||||||||
| FirstName: | DONNA | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | LPN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3 WALNUT ST | ||||||||
| Address2: | |||||||||
| City: | LEMOYNE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170431168 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7179880201 | ||||||||
| FaxNumber: | 7177612023 | ||||||||
| Practice Location | |||||||||
| Address1: | 3 WALNUT ST | ||||||||
| Address2: | |||||||||
| City: | LEMOYNE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170431168 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7179880201 | ||||||||
| FaxNumber: | 7177612023 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/03/2019 | ||||||||
| LastUpdateDate: | 01/03/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | PN065746L | PA | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.