Provider Demographics
NPI:1205562717
Name:MULKEY, RENNETTA LYNNETTE (STUDENT MIDWIFE)
Entity type:Individual
Prefix:
First Name:RENNETTA
Middle Name:LYNNETTE
Last Name:MULKEY
Suffix:
Gender:F
Credentials:STUDENT MIDWIFE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3114 34TH AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-6128
Mailing Address - Country:US
Mailing Address - Phone:206-765-8049
Mailing Address - Fax:
Practice Address - Street 1:3114 34TH AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144-6128
Practice Address - Country:US
Practice Address - Phone:206-765-8049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-27
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0Medicaid