Provider Demographics
NPI:1437185329
Name:MUELLER, DIANE MARY (NP)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:MARY
Last Name:MUELLER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 SUNNYVIEW LN
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3129
Mailing Address - Country:US
Mailing Address - Phone:406-751-5310
Mailing Address - Fax:
Practice Address - Street 1:310 SUNNYVIEW LN
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3129
Practice Address - Country:US
Practice Address - Phone:406-751-5310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2017-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO990307363L00000X
MO089766363L00000X
KS45806363LF0000X
MT104274363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100344220BMedicaid
NE1437185329Medicaid
MT1437185329Medicaid
CO30422558Medicaid
ID1760794481Medicaid
MO424669018Medicaid
NM71581570Medicaid
S85533Medicare UPIN
CO30422558Medicaid
KS100344220BMedicaid
MO831125236Medicare PIN
COCOA105112Medicare PIN