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Contact Information

DANETTE R ELLIOTT MULLENS, DO
2650 NE COURTNEY DR
BEND, OR97701-7636
 Phone: 541-647-5200
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Internal Medicine

207R00000X 11 Physician/Internal Medicine
 

Adolescent Medicine

2080A0000X 37 Physician/Pediatric Medicine
Indicates primary specialty

NPI Profile & details for DANETTE R ELLIOTT MULLENS · (Female)

NPI # 1417977042
Status Active
Credentials DO (Doctor of Osteopathic)
Entity Individual
Enumeration date 07/19/2006
Last updated 04/11/2024 - About 2 years ago
Sole proprietor 1 No
Identifiers
  • OR License # DO150943
  • TX License # K9775
  • OR Medicaid 500621599
  • TX Medicaid 143444105
  • MO Other 2023050669 MO STATE BOARD OF REGISTRATION
  • TX Other 8AJ420 BCBS INDIV PROV #
  • TX Other 15402701 MEDICAID TPI BILLING NUMBER
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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