Provider Demographics
NPI:1902346380
Name:MULLINS, ABIGAIL KARLENE (BSN,RNC,LCCE,IBCLC)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:KARLENE
Last Name:MULLINS
Suffix:
Gender:F
Credentials:BSN,RNC,LCCE,IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4440 CHANCELLOR DR
Mailing Address - Street 2:
Mailing Address - City:DEWITT
Mailing Address - State:MI
Mailing Address - Zip Code:48820-7861
Mailing Address - Country:US
Mailing Address - Phone:773-870-2899
Mailing Address - Fax:
Practice Address - Street 1:4440 CHANCELLOR DR
Practice Address - Street 2:
Practice Address - City:DEWITT
Practice Address - State:MI
Practice Address - Zip Code:48820-7861
Practice Address - Country:US
Practice Address - Phone:773-870-2899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-03
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704251764163WM0102X, 163WL0100X
MI15117174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn
No174H00000XOther Service ProvidersHealth Educator