Provider Demographics
NPI:1386611366
Name:MULLEN-DEWITT, LAURA ANN (LM)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ANN
Last Name:MULLEN-DEWITT
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 CADILLAC DR
Mailing Address - Street 2:SUITE 230
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-5453
Mailing Address - Country:US
Mailing Address - Phone:916-920-2082
Mailing Address - Fax:916-920-1430
Practice Address - Street 1:77 CADILLAC DR
Practice Address - Street 2:SUITE 230
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-5453
Practice Address - Country:US
Practice Address - Phone:916-920-2082
Practice Address - Fax:916-920-1430
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALM70175M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175M00000XOther Service ProvidersMidwife, Lay