Most Relevant Information
Provider Data
| NPI Number: | 1003339987 |
| Provider Name: | MARISA TAILOR MULLEN |
| Entity Type: | Individual |
| Taxonomy Code: | 3747A0650X |
| Specialty: | Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 07/21/2017 |
| Last Updated: | 12/27/2018 |
Provider Practice Location
502 SILVERSMITH PL
RENO
NV
895118148
Practice Location Phone/Fax
| Phone: | 5303003898 |
| Fax: |
Provider Mailing Location
3245 CLOVER WAY # 4-313
RENO
NV
895094786
Provider Mailing Phone/Fax
| Phone: | 5303003898 |
| Fax: |