Provider Demographics
NPI:1528137999
Name:MULLEN, JUDITH A (CNS, CDE)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:A
Last Name:MULLEN
Suffix:
Gender:F
Credentials:CNS, CDE
Other - Prefix:
Other - First Name:JUDY
Other - Middle Name:A
Other - Last Name:MULLEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2828 PAA ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819-4405
Mailing Address - Country:US
Mailing Address - Phone:808-432-5831
Mailing Address - Fax:
Practice Address - Street 1:2828 PAA ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-4405
Practice Address - Country:US
Practice Address - Phone:808-432-5831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN-393364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI55681301Medicaid
HI0000248161OtherHMSA BILLING NUMBER
HI0000248161OtherHMSA BILLING NUMBER
HI55681301Medicaid