Provider Demographics
NPI:1164149175
Name:MUELLER, NICOLE LEA (BSN)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:LEA
Last Name:MUELLER
Suffix:
Gender:F
Credentials:BSN
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3910 BRUNSWICK LN
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53546-2081
Mailing Address - Country:US
Mailing Address - Phone:608-449-9103
Mailing Address - Fax:
Practice Address - Street 1:3910 BRUNSWICK LN
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53546-2081
Practice Address - Country:US
Practice Address - Phone:608-449-9103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-21
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI149195163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse