Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | C10009889 | DE |
N | 207PP0204X | Pediatric Emergency Physician | MD-059812-L | PA |
NPI | 1588616544 |
---|---|
Provider Name | Dr. Colette Collins Mull |
First Address | Rockland, DE 19732-0191 |
Second Address | Wilmington, DE 19803-3607 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2006 |
Last Update Date | 15/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0017362300001 | (05) | PA |
G87061 | (02) | PA |