1902133564 NPI number — JOY MULLINGS R.N.

Table of content: JOY MULLINGS R.N. (NPI 1902133564)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902133564 NPI number — JOY MULLINGS R.N.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MULLINGS
Provider First Name:
JOY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
R.N.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902133564
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/03/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7720
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW HAVEN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06519-0720
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-503-3452
Provider Business Mailing Address Fax Number:
203-503-3422

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
226 DIXWELL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW HAVEN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06511-3456
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-503-3452
Provider Business Practice Location Address Fax Number:
203-503-3422
Provider Enumeration Date:
11/03/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  E58471 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 004235900 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".