Basic Information
| Provider Information | |||||||||
| NPI: | 1740474162 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCMULLEN | ||||||||
| FirstName: | PATRICIA | ||||||||
| MiddleName: | CATHLEEN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | CRNP, PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 12622 | ||||||||
| Address2: | |||||||||
| City: | BELFAST | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049154017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4434816483 | ||||||||
| FaxNumber: | 4434816515 | ||||||||
| Practice Location | |||||||||
| Address1: | 2401 BRANDERMILL BLVD | ||||||||
| Address2: | |||||||||
| City: | GAMBRILLS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210541690 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4104510076 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2007 | ||||||||
| LastUpdateDate: | 12/03/2013 | ||||||||
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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 | 163WW0101X | R056995 | MD | Y | Nursing Service Providers | Registered Nurse | Women's Health Care, Ambulatory | 163WW0101X | RN1004832 | DC | N | Nursing Service Providers | Registered Nurse | Women's Health Care, Ambulatory |
ID Information
| ID | Type | State | Issuer | Description | 91709001 | 01 | BCBS MD | OTHER | 413558000 | 05 | MD | MEDICAID | 91709003 | 01 | BCBS | OTHER | 81610003 | 01 | BCBS DC | OTHER | 91709002 | 01 | CAREFIRST | OTHER |