Provider Demographics
NPI:1508346750
Name:PRECISION HEALTH FAMILY FUNCTIONAL MEDICINE, PA, LLC
Entity Type:Organization
Organization Name:PRECISION HEALTH FAMILY FUNCTIONAL MEDICINE, PA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:BONNIE
Authorized Official - Last Name:MUELLER
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:207-219-8446
Mailing Address - Street 1:10 PLAZA DR STE 203
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-1801
Mailing Address - Country:US
Mailing Address - Phone:207-219-8445
Mailing Address - Fax:888-965-0540
Practice Address - Street 1:10 PLAZA DR STE 203
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-1801
Practice Address - Country:US
Practice Address - Phone:207-219-8445
Practice Address - Fax:888-965-0540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-17
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP101009261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty