| NPI | 1871935965 |
|---|---|
| Former Name | THERESA MARIE MULLAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA056243) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA OA003083) |
| Enumeration Date | 2013-07-18 |
| Last Update Date | 2020-10-07 |