Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 2581 | WI |
NPI | 1003867961 |
---|---|
Provider Name | Dr. Michelle Marie Mueller |
First Address | Green Bay, WI 54303-2498 |
Second Address | Green Bay, WI 54303-2498 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
38590100 | (05) | WI |
U45945 | (02) | WI |