Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 15423 | HI |
N | 207QA0401X | Family Doctor - Addiction Medicine | G49523 | CA |
NPI | 1497846349 |
---|---|
Provider Name | Dr. Patricia Lynn Mullen |
First Address | Pahala, HI 96777-0040 |
Second Address | Pahala, HI 96777 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2006 |
Last Update Date | 17/12/2012 |