Provider Demographics
NPI:1518090554
Name:MUELLER, DWAYNE WARREN (RN)
Entity Type:Individual
Prefix:MR
First Name:DWAYNE
Middle Name:WARREN
Last Name:MUELLER
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2602 PEBBLE BEACH DR
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-3283
Mailing Address - Country:US
Mailing Address - Phone:219-464-2461
Mailing Address - Fax:219-886-1319
Practice Address - Street 1:308 E 21ST AVE
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46407-2618
Practice Address - Country:US
Practice Address - Phone:219-886-1320
Practice Address - Fax:219-886-1319
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28073719A163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator