Active NPI
Susan Theresa Mullanack, LMT
- Homeopath
- Fort Pierce, FL
National Provider Identifier
1366779605
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Homeopath
- License
- MA 54135
- Practice address
- 4695 Seminole Road
Fort Pierce, FL 34951 - Phone
- (772) 584-0794
- NPI assigned
- Nov 6, 2009
- Last updated
- Nov 6, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Homeopath | 175L00000X | MA 54135 | FL | Primary |
Addresses
Primary practice location
4695 Seminole Road
Fort Pierce, FL 34951
Mailing address
4695 Seminole Road
Fort Pierce, FL 34951
Phone (772) 584-0794
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MA 54135 | FL | MD | Homeopath |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1257465600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1257465600000",
"number": "1366779605",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4695 SEMINOLE ROAD",
"city": "FORT PIERCE",
"state": "FL",
"postal_code": "34951",
"telephone_number": "772-584-0794"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4695 SEMINOLE ROAD",
"city": "FORT PIERCE",
"state": "FL",
"postal_code": "34951",
"telephone_number": "772-584-0794"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MULLANACK",
"first_name": "SUSAN",
"middle_name": "THERESA",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-11-06",
"last_updated": "2009-11-06",
"status": "A"
},
"taxonomies": [
{
"code": "175L00000X",
"taxonomy_group": "",
"desc": "Homeopath",
"state": "FL",
"license": "MA 54135",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Pierce, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.