Individual
MRS. DEBORAH LYNN MULLINAX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
916 JACKSON AVE, SHERIDAN, WY 82801-2708
(307) 672-6451
(307) 672-1704
Mailing address
2335 PAPAGO DR, SHERIDAN, WY 82801-5835
(307) 674-6093
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
344
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000405665
—
MT
01
—
00941001
BCBS GROUP
WY
05
—
100048900
—
WY
01
—
313672
BCBS INDIV
WY
05
—
7705130
—
SD
05
—
830245718-13
—
NE
Enumeration date
01/27/2006
Last updated
01/12/2021
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