Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | 303074 | LA |
N | 208000000X | Pediatrician | 49242 | TN |
NPI | 1801115720 |
---|---|
Provider Name | Lauren Mullins Mutter |
First Address | New Orleans, LA 70121-2429 |
Second Address | Jefferson, LA 70121-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2010 |
Last Update Date | 25/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
06738500 | (05) | MS |
2429493 | (05) | LA |