Individual
SHARON MARIE MULLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
200 EMILIO LOPEZ RD NW, PMG LOS LUNAS, LOS LUNAS, NM 87031-6818
(505) 866-2700
(505) 866-2701
Mailing address
PO BOX 26666, PHS PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
(505) 923-6770
(505) 923-5354
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
3834
IA
207Q00000X
Family Medicine Physician
Primary
A-1536-10
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
18503829
—
NM
Enumeration date
09/06/2007
Last updated
11/09/2015
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