Individual
MARY MCNULTY
Active
Sole proprietor
Provider details
NPI number
Gender
F
Contact information
Practice address
1 JARRETT WHITE RD, TRIPLER ARMY MEDICAL CENTER ATTN: MCHK-QS, TRIPLER AMC, HI 96859-5001
(808) 433-2460
Mailing address
1 JARRETT WHITE RD, TRIPLER ARMY MEDICAL CENTER ATTN: MCHK-QS, TRIPLER AMC, HI 96859-5001
(808) 433-2460
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LPN14793
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LPN14793
LICENSE
HI
01
—
PN082793L
LICENSE
PA
Enumeration date
12/28/2005
Last updated
07/08/2007
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