Individual
JEROLD LEE MULLINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
8990 SPRINGBROOK DR NW, STE 250, COON RAPIDS, MN 55433-5850
(763) 398-0099
(763) 398-0124
Mailing address
12448 296TH AVE, PRINCETON, MN 55371-9138
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R 082378-2
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
268T6MU
BCBSMN
MN
05
—
367542400
—
MN
Enumeration date
08/12/2005
Last updated
10/09/2008
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