1437165966 NPI number — ANNA MULLENS CNP

Table of content: ANNA MULLENS CNP (NPI 1437165966)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437165966 NPI number — ANNA MULLENS CNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MULLENS
Provider First Name:
ANNA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KIRCHGESSNER
Provider Other First Name:
ANNA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1437165966
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/03/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 E PENNSYLVANIA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PEORIA
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61603-3089
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
309-655-7990
Provider Business Mailing Address Fax Number:
309-655-7953

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 E PENNSYLVANIA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEORIA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61603-3089
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
309-655-7990
Provider Business Practice Location Address Fax Number:
309-655-7953
Provider Enumeration Date:
08/01/2006

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: 363L00000X , with the licence number:  041327213 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0413272131 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7215059 . This is a "BCBS PPO" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: CA4079 . This is a "RR MEDICARE GROUP PTAN" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: IL01T9 . This is a "JOHN DEERE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 099736 . This is a "HEALTH ALLIANCE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 623711 . This is a "HEALTHLINK" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: P00625599 . This is a "RR MEDICARE MEMBER PTAN" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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