Provider Demographics
NPI:1538611355
Name:MUELLER, SHELBY HAYDEN (AGPCNP-BC)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:HAYDEN
Last Name:MUELLER
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:HAYDEN
Other - Last Name:CONNOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10209 STATHOS DR
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-5995
Mailing Address - Country:US
Mailing Address - Phone:720-244-1927
Mailing Address - Fax:
Practice Address - Street 1:1500 21ST ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95811-5216
Practice Address - Country:US
Practice Address - Phone:916-443-3299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-27
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95005304363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner