Provider Demographics
NPI:1548239767
Name:MULLINS, LAURA S (NP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:S
Last Name:MULLINS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:200 N PARK ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-3731
Mailing Address - Country:US
Mailing Address - Phone:269-373-7488
Mailing Address - Fax:269-373-0123
Practice Address - Street 1:9072 N 42ND ST
Practice Address - Street 2:
Practice Address - City:HICKORY CORNERS
Practice Address - State:MI
Practice Address - Zip Code:49060-9542
Practice Address - Country:US
Practice Address - Phone:269-373-7488
Practice Address - Fax:269-373-0123
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704084579363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
7309236OtherAETNA
MI1548239767Medicaid
MI4332789Medicaid
7309236OtherAETNA