Provider Demographics
NPI:1457124281
Name:MUTER, NOELLE CHRISTINE (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:NOELLE
Middle Name:CHRISTINE
Last Name:MUTER
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:NOELLE
Other - Middle Name:CHRISTINE
Other - Last Name:LARSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2184 POTTER DR
Mailing Address - Street 2:
Mailing Address - City:DE PERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115-7732
Mailing Address - Country:US
Mailing Address - Phone:920-227-5038
Mailing Address - Fax:
Practice Address - Street 1:1496 BELLEVUE ST STE 502
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311-4251
Practice Address - Country:US
Practice Address - Phone:920-264-0996
Practice Address - Fax:920-932-3114
Is Sole Proprietor?:No
Enumeration Date:2023-11-02
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14331-33363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health