Provider Demographics
NPI:1851779185
Name:MUELLER, CARLI V
Entity Type:Individual
Prefix:MISS
First Name:CARLI
Middle Name:V
Last Name:MUELLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N546 SCHROETER DR
Mailing Address - Street 2:
Mailing Address - City:RANDOM LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:53075-1272
Mailing Address - Country:US
Mailing Address - Phone:920-627-4295
Mailing Address - Fax:
Practice Address - Street 1:N546 SCHROETER DR
Practice Address - Street 2:
Practice Address - City:RANDOM LAKE
Practice Address - State:WI
Practice Address - Zip Code:53075-1272
Practice Address - Country:US
Practice Address - Phone:920-627-4295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-06
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program