Provider Demographics
NPI:1881704120
Name:MUELLER, CAROLYN JANE (RN,MS,FNP)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:JANE
Last Name:MUELLER
Suffix:
Gender:F
Credentials:RN,MS,FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MUIR RD
Mailing Address - Street 2:ENSENADA BLDG
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553
Mailing Address - Country:US
Mailing Address - Phone:925-372-1036
Mailing Address - Fax:
Practice Address - Street 1:200 MUIR RD
Practice Address - Street 2:ENSENADA BLDG
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-4614
Practice Address - Country:US
Practice Address - Phone:925-372-1036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA331543363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN331543Medicare ID - Type Unspecified