Basic Information
| Provider Information | |||||||||
| NPI: | 1710085063 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MULVANY | ||||||||
| FirstName: | MONIQUE | ||||||||
| MiddleName: | SOMMER | ||||||||
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| Credential: | N.P | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5508 PARKCREST DR STE 310 | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787314915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124209900 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5508 PARKCREST DR STE 310 | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787314915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124209900 | ||||||||
| FaxNumber: | 5124209944 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 09/27/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 670959 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | RN670959 | 01 | TX | TX NURSING BOARD | OTHER | AP114954 | 01 | TX | TX NURSING BOARD | OTHER |