Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 8320-33 | WI |
NPI | 1003313230 |
---|---|
Provider Name | Colleen Ann Mueller |
First Address | Minocqua, WI 54548-9099 |
Second Address | Minocqua, WI 54548-9099 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2018 |
Last Update Date | 13/04/2018 |