Provider Demographics
NPI:1932234085
Name:KIRK-MCMULLEN, CHERYL L (OTR)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:L
Last Name:KIRK-MCMULLEN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12404 LOS ARBOLES AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-2076
Mailing Address - Country:US
Mailing Address - Phone:505-350-0949
Mailing Address - Fax:505-323-8362
Practice Address - Street 1:12404 LOS ARBOLES AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-2076
Practice Address - Country:US
Practice Address - Phone:505-350-0949
Practice Address - Fax:505-323-8362
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1873171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor