Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0207X | Pediatric Hematology-Oncologist | 46269 | KY |
NPI | 1174770374 |
---|---|
Provider Name | Dr. Jennifer Rose Mullinax |
First Address | Louisville, KY 40242-7911 |
Second Address | Louisville, KY 40202-3818 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2008 |
Last Update Date | 31/07/2013 |