Provider Demographics
NPI:1144658485
Name:MULLINGS, PEARLETTA
Entity type:Individual
Prefix:
First Name:PEARLETTA
Middle Name:
Last Name:MULLINGS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3460 EASTCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-1639
Mailing Address - Country:US
Mailing Address - Phone:917-669-9138
Mailing Address - Fax:
Practice Address - Street 1:85 BARTLETT ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-4429
Practice Address - Country:US
Practice Address - Phone:866-387-8100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-24
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY224718-1164W00000X, 172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No172V00000XOther Service ProvidersCommunity Health Worker