Provider Demographics
NPI:1124132402
Name:MULDER-CARROLL, JOLYNN SUE (MSN, NP)
Entity type:Individual
Prefix:MRS
First Name:JOLYNN
Middle Name:SUE
Last Name:MULDER-CARROLL
Suffix:
Gender:F
Credentials:MSN, NP
Other - Prefix:MISS
Other - First Name:JOLYNN
Other - Middle Name:SUE
Other - Last Name:MULDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:910 E LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:IONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48846-1393
Mailing Address - Country:US
Mailing Address - Phone:616-527-2370
Mailing Address - Fax:616-527-3824
Practice Address - Street 1:910 E LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:IONIA
Practice Address - State:MI
Practice Address - Zip Code:48846-1393
Practice Address - Country:US
Practice Address - Phone:616-527-2370
Practice Address - Fax:616-527-3824
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704114059363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily