Individual
MATTHEW MULLINIX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2100 W SUNSET DR, RIVERTON, WY 82501-2274
(800) 967-1646
(317) 567-2191
Mailing address
PO BOX 32103, BILLINGS, MT 59107-2103
(317) 567-2180
(317) 567-2191
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
22560.355
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1063457893
—
WY
01
—
315565
BCBS
WY
01
—
P00435055
RAILROAD MEDICARE
WY
Enumeration date
06/17/2006
Last updated
11/25/2009
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