Individual
MRS. SHANNON RAE MULLINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
2254 IMPERIAL LN, GREEN BAY, WI 54302
(715) 661-2206
Mailing address
2254 IMPERIAL LN, GREEN BAY, WI 54302
(715) 661-2206
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
176886
WI
164W00000X
Licensed Practical Nurse
176886
WI
Other
Enumeration date
04/10/2015
Last updated
04/15/2015
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