Individual
STEPHANIE NICOLE MCMULLEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-S, CSA, MSA
Contact information
Practice address
1020 FIRST COLONIAL RD STE A, VIRGINIA BEACH, VA 23454-3078
(757) 395-1850
Mailing address
1020 FIRST COLONIAL RD STE A, VIRGINIA BEACH, VA 23454-3078
(757) 395-1850
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110007948
VA
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
12/08/2020
Last updated
10/17/2024
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