Provider Demographics
NPI:1366893893
Name:MULLENHOUR, MARY JANE (LPN)
Entity type:Individual
Prefix:
First Name:MARY JANE
Middle Name:
Last Name:MULLENHOUR
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1158 WESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:VAN WERT
Mailing Address - State:OH
Mailing Address - Zip Code:45891-2449
Mailing Address - Country:US
Mailing Address - Phone:419-238-3434
Mailing Address - Fax:
Practice Address - Street 1:501 MC DONALD PIKE
Practice Address - Street 2:
Practice Address - City:PAULDING
Practice Address - State:OH
Practice Address - Zip Code:45879-9239
Practice Address - Country:US
Practice Address - Phone:419-399-3636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-27
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN025051MIV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse