Staci M Mullen, RN

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

617017 Issued in NY

Practice address

49 South Church St
Canaseraga, NY 14822

Phone

(607) 545-6197

NPI assigned

Sep 2, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Staci M French Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1599004800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599004800000",
    "number": "1154935682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 112",
            "city": "CANASERAGA",
            "state": "NY",
            "postal_code": "148220112",
            "telephone_number": "607-545-6197"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "49 SOUTH CHURCH ST",
            "city": "CANASERAGA",
            "state": "NY",
            "postal_code": "14822",
            "telephone_number": "607-545-6197"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MULLEN",
        "first_name": "STACI",
        "middle_name": "M",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-09-02",
        "last_updated": "2020-09-02",
        "certification_date": "2020-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "617017",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STACI",
            "last_name": "FRENCH",
            "middle_name": "M",
            "credential": "RN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Canaseraga Central School
• Donna Marie Gordon, RN
• Shelby Gross, FNP-C
• Bruce Mackellar, MD
• Lauren Marino, RPA-C
• Zinovia Pappas, RN,BSN
• Christine M Porter, RN-BC
• Sierra Quinlan, PA-C
• Shauna Roberts
• Howard Thomas Sleggs, PTA

• Registered Nurse in Canaseraga, NY
• Providers in Canaseraga, NY by specialty
• Registered Nurse in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.