Provider Demographics
NPI:1912493784
Name:ZHU MAULDIN, XIAOYUAN (XIAOYUAN)
Entity type:Individual
Prefix:
First Name:XIAOYUAN
Middle Name:
Last Name:ZHU MAULDIN
Suffix:
Gender:F
Credentials:XIAOYUAN
Other - Prefix:
Other - First Name:XIAOYUAN
Other - Middle Name:ZHU
Other - Last Name:MAULDIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3751 SULLIVAN ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-1707
Mailing Address - Country:US
Mailing Address - Phone:256-772-4211
Mailing Address - Fax:
Practice Address - Street 1:3751 SULLIVAN ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758
Practice Address - Country:US
Practice Address - Phone:256-772-4211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-05
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-148724363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner