Provider Demographics
NPI:1083073746
Name:MUELLER, LISA (RN BSN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:MUELLER
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:USA MEDDAC, RWBAHC
Mailing Address - Street 2:2240 WINROW AVE
Mailing Address - City:FORT HUACHUCA
Mailing Address - State:AZ
Mailing Address - Zip Code:85613-7079
Mailing Address - Country:US
Mailing Address - Phone:520-533-9162
Mailing Address - Fax:520-533-5328
Practice Address - Street 1:USA MEDDAC, RWBAHC
Practice Address - Street 2:2240 WINROW AVE
Practice Address - City:FORT HUACHUCA
Practice Address - State:AZ
Practice Address - Zip Code:85650-7079
Practice Address - Country:US
Practice Address - Phone:520-533-9162
Practice Address - Fax:520-533-5328
Is Sole Proprietor?:No
Enumeration Date:2016-02-23
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN090640163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZRN090640OtherSTATE BOARD OF NURSING