Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | F306016-1 | NY |
NPI | 1003165911 |
---|---|
Provider Name | Joy Therese Mullen |
First Address | Brooklyn, NY 11215-3609 |
Second Address | Brooklyn, NY 11215-3609 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2012 |
Last Update Date | 06/11/2012 |