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:
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Mailing Address - Street 1:9615 E 148TH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-4371
Mailing Address - Country:US
Mailing Address - Phone:317-574-1254
Mailing Address - Fax:317-674-0060
Practice Address - Street 1:1600 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:IN
Practice Address - Zip Code:46052-2388
Practice Address - Country:US
Practice Address - Phone:317-574-1254
Practice Address - Fax:317-674-0060
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
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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