Provider Demographics
NPI:1992703789
Name:MUELLER, NICOLE ALISON (DO)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:ALISON
Last Name:MUELLER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MRS
Other - First Name:NICOLE
Other - Middle Name:ALISON
Other - Last Name:DESARITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1201 MEDICAL PLAZA CT
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76048-5684
Mailing Address - Country:US
Mailing Address - Phone:817-279-9333
Mailing Address - Fax:817-573-6234
Practice Address - Street 1:1201 MEDICAL PLAZA CT
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048-5684
Practice Address - Country:US
Practice Address - Phone:817-279-9333
Practice Address - Fax:817-573-6234
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7060207W00000X
MI5101014224207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX163068301Medicaid
TXH97785Medicare UPIN
TX8B2589Medicare PIN
TX163068301Medicaid