Provider Demographics
NPI:1407956949
Name:MUELLER, SHARON L (LPN)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:L
Last Name:MUELLER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:748 ENLOE RD
Mailing Address - Street 2:
Mailing Address - City:REWEY
Mailing Address - State:WI
Mailing Address - Zip Code:53580-9658
Mailing Address - Country:US
Mailing Address - Phone:608-943-6091
Mailing Address - Fax:
Practice Address - Street 1:748 ENLOE RD
Practice Address - Street 2:
Practice Address - City:REWEY
Practice Address - State:WI
Practice Address - Zip Code:53580-9658
Practice Address - Country:US
Practice Address - Phone:608-943-6091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI19514031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39820400Medicaid