1083809149 NPI number — JEANNIE JO MUELLER PA-C, RD, CDE

Table of content: JEANNIE JO MUELLER PA-C, RD, CDE (NPI 1083809149)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083809149 NPI number — JEANNIE JO MUELLER PA-C, RD, CDE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MUELLER
Provider First Name:
JEANNIE
Provider Middle Name:
JO
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C, RD, CDE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083809149
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/26/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 529
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OLATHE
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81425-0529
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-323-6141
Provider Business Mailing Address Fax Number:
970-323-6117

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1010 RIO GRANDE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTROSE
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81401-4831
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-497-3333
Provider Business Practice Location Address Fax Number:
855-299-7837
Provider Enumeration Date:
09/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 18408745 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: P01316438 . This is a "RAILROAD WORKERS MEDICARE / OLATHE COMM CLINIC DBA RIVER VALLEY FAMILY HEALTH" identifier . This identifiers is of the category "OTHER".




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