Provider Demographics
NPI:1033528450
Name:MULLENNIEX, NYEIN WINT (CAA)
Entity type:Individual
Prefix:
First Name:NYEIN WINT
Middle Name:
Last Name:MULLENNIEX
Suffix:
Gender:F
Credentials:CAA
Other - Prefix:
Other - First Name:NYEIN
Other - Middle Name:
Other - Last Name:GARNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CAA
Mailing Address - Street 1:809 82ND PKWY
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29572-4607
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:134 N GATE RD
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29572-5618
Practice Address - Country:US
Practice Address - Phone:843-272-7232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-11
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1804367H00000X
NMAA2017-001367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant