Provider Demographics
NPI:1871778589
Name:MULLIN, STEPHANIE (CNP)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:MULLIN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:KAMIAB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:215 W BOWERY ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44308-1069
Mailing Address - Country:US
Mailing Address - Phone:330-543-4488
Mailing Address - Fax:330-543-5060
Practice Address - Street 1:1 PERKINS SQ
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44308-1063
Practice Address - Country:US
Practice Address - Phone:330-543-4488
Practice Address - Fax:330-543-5060
Is Sole Proprietor?:No
Enumeration Date:2008-01-02
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.08937-NP363L00000X
OHNP08937363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2801678Medicaid
OH753957OtherBUCKEYE
OHMUNP25531Medicare PIN
OHH006580Medicare PIN
OH7209439OtherAETNA
OH000000233295OtherUNISON