Individual
ANNA MULLENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
200 E PENNSYLVANIA AVE, PEORIA, IL 61603-3089
(309) 655-7990
(309) 655-7953
Mailing address
200 E PENNSYLVANIA AVE, PEORIA, IL 61603-3089
(309) 655-7990
(309) 655-7953
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
041327213
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0413272131
—
IL
01
—
099736
HEALTH ALLIANCE
IL
01
—
623711
HEALTHLINK
IL
01
—
7215059
BCBS PPO
IL
01
—
CA4079
RR MEDICARE GROUP PTAN
IL
01
—
IL01T9
JOHN DEERE
IL
01
—
P00625599
RR MEDICARE MEMBER PTAN
IL
Enumeration date
08/01/2006
Last updated
11/03/2008
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