Provider Demographics
NPI:1225115702
Name:MUELLER, MARY (NP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:MUELLER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 STEEPLECHASE CT
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-8545
Mailing Address - Country:US
Mailing Address - Phone:765-413-1920
Mailing Address - Fax:
Practice Address - Street 1:44 STEEPLECHASE CT
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-8545
Practice Address - Country:US
Practice Address - Phone:765-413-1920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000180363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN160120AMedicare PIN
INR33059Medicare UPIN