Provider Demographics
NPI:1215130190
Name:MULLEN, ELIZABETH A (PNP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:MULLEN
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 HOLLY RD
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02050-1725
Mailing Address - Country:US
Mailing Address - Phone:888-897-8947
Mailing Address - Fax:617-772-5519
Practice Address - Street 1:253 SUMMER ST
Practice Address - Street 2:5TH FLR - CMA
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02210-1114
Practice Address - Country:US
Practice Address - Phone:888-897-8947
Practice Address - Fax:617-772-5519
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA91062363LC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health