Individual
LINDA MULLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1200 N BEAVER ST, FLAGSTAFF, AZ 86001-3118
(928) 213-6415
(928) 213-6409
Mailing address
1200 N BEAVER ST, PAYER CREDENTIALING, FLAGSTAFF, AZ 86001-3118
(928) 773-2559
(928) 213-6292
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
30274
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
26051391
MEDICARE RAILROAD
—
01
—
30274
AZ LICENSE
AZ
05
—
699291
—
AZ
Enumeration date
10/21/2005
Last updated
12/08/2015
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