Provider Demographics
NPI:1063759629
Name:MULLANEY, MAGEN ELIZABETH (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:MAGEN
Middle Name:ELIZABETH
Last Name:MULLANEY
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 FULTON AVE
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-2315
Mailing Address - Country:US
Mailing Address - Phone:845-473-8996
Mailing Address - Fax:
Practice Address - Street 1:15 FULTON AVE
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-2315
Practice Address - Country:US
Practice Address - Phone:845-473-8996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-15
Last Update Date:2017-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF337556-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily