Provider Demographics
NPI:1093431918
Name:MULLER, MICKEY MASON (DNP)
Entity Type:Individual
Prefix:
First Name:MICKEY
Middle Name:MASON
Last Name:MULLER
Suffix:
Gender:M
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 DAIRYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:MILLTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:54858-9017
Mailing Address - Country:US
Mailing Address - Phone:715-553-1285
Mailing Address - Fax:
Practice Address - Street 1:5200 FAIRVIEW BLVD
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MN
Practice Address - Zip Code:55092-8013
Practice Address - Country:US
Practice Address - Phone:651-982-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-12
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9597363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily