Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 4958 | CO |
NPI | 1073641049 |
---|---|
Provider Name | Ms. Mary Ellen Mullins |
First Address | Centennial, CO 80112-4028 |
Second Address | Centennial, CO 80112-4028 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2007 |
Last Update Date | 08/07/2007 |