Provider Demographics
NPI:1851647598
Name:MULLET, LOIS NADINE (NP-C)
Entity type:Individual
Prefix:
First Name:LOIS
Middle Name:NADINE
Last Name:MULLET
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16030 E HIGH ST
Mailing Address - Street 2:PO BOX 1027
Mailing Address - City:MIDDLEFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44062-9474
Mailing Address - Country:US
Mailing Address - Phone:440-632-0770
Mailing Address - Fax:
Practice Address - Street 1:16030 E HIGH ST
Practice Address - Street 2:
Practice Address - City:MIDDLEFIELD
Practice Address - State:OH
Practice Address - Zip Code:44062-9474
Practice Address - Country:US
Practice Address - Phone:440-632-0770
Practice Address - Fax:440-632-0321
Is Sole Proprietor?:No
Enumeration Date:2012-07-31
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHF0612187363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0070078Medicaid
OH1851647598Medicare PIN
OH0070078Medicaid