Individual
DONNA MULLAHY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
350 S NORTHWEST HWY STE 106, PARK RIDGE, IL 60068-4262
(847) 470-1500
(847) 470-1550
Mailing address
350 S NORTHWEST HWY STE 106, PARK RIDGE, IL 60068-4262
(847) 470-1500
(847) 470-1550
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085002001
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001619727
BCBS OF ILLINOIS
IL
Enumeration date
11/02/2006
Last updated
12/08/2021
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