Provider Demographics
NPI:1588134175
Name:MULLIN, AUDRIE BROOK (FNP-BC)
Entity type:Individual
Prefix:
First Name:AUDRIE
Middle Name:BROOK
Last Name:MULLIN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:AUDRIE
Other - Middle Name:BROOK
Other - Last Name:BEDENIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:2313 E. HILL RD
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439
Mailing Address - Country:US
Mailing Address - Phone:810-496-0900
Mailing Address - Fax:810-695-6497
Practice Address - Street 1:2313 E. HILL RD
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439
Practice Address - Country:US
Practice Address - Phone:810-496-0900
Practice Address - Fax:810-695-6497
Is Sole Proprietor?:No
Enumeration Date:2018-11-27
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704306519163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse