Provider Demographics
NPI:1316663412
Name:MULLEN, REBECCA SUE
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:SUE
Last Name:MULLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:SUE
Other - Last Name:MASTERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:83 MECHANIC STREET
Mailing Address - Street 2:
Mailing Address - City:ANGELICA
Mailing Address - State:NY
Mailing Address - Zip Code:14709
Mailing Address - Country:US
Mailing Address - Phone:585-991-9388
Mailing Address - Fax:
Practice Address - Street 1:83 MECHANIC STREET
Practice Address - Street 2:
Practice Address - City:ANGELICA
Practice Address - State:NY
Practice Address - Zip Code:14709
Practice Address - Country:US
Practice Address - Phone:585-991-9388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-19
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY469327-01163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health