Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1053658674 |
---|---|
Provider Name | Jerieth Mueller |
First Address | Yerington, NV 89447-8722 |
Second Address | Yerington, NV 89447-8722 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2013 |
Last Update Date | 16/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
225400000X | (05) | NV |