Provider Demographics
NPI:1770238537
Name:MUELLER, MIKAYLA MARIE (RN)
Entity Type:Individual
Prefix:
First Name:MIKAYLA
Middle Name:MARIE
Last Name:MUELLER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 BROWNSTONE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-4100
Mailing Address - Country:US
Mailing Address - Phone:860-681-2664
Mailing Address - Fax:
Practice Address - Street 1:90 BROWNSTONE DR
Practice Address - Street 2:
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489-4100
Practice Address - Country:US
Practice Address - Phone:860-681-2664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-19
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT11775363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner