Provider Demographics
NPI:1366477408
Name:MULHERON, MARILYNN (FNP)
Entity type:Individual
Prefix:
First Name:MARILYNN
Middle Name:
Last Name:MULHERON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:
Other - Last Name:SIDARI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1820 E BELL DE MAR DR # N226
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-4198
Mailing Address - Country:US
Mailing Address - Phone:413-404-3076
Mailing Address - Fax:845-237-5910
Practice Address - Street 1:26 QUEEN ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01610-2473
Practice Address - Country:US
Practice Address - Phone:508-860-7777
Practice Address - Fax:508-860-7862
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61173565363LF0000X
MARN211041363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ833568Medicaid
AZZ131325Medicare PIN