MEDICARE: JENNIFER RAE MULLER FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	201800202NP-PP	OR

General Provider Information

NPI Number	:	1215306634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER RAE MULLER FNP-C

Provider Business Mailing Address
First Line	:	361 NE KIRBY AVE
Second Line	:
City	:	ROSEBURG
State	:	OR
Zip	:	97470-5456
Country	:	US
Telephone Number	:	541-430-7551
Fax Number	:

Provider Business Practice Location Address
First Line	:	1375 N 10TH AVE
Second Line	:
City	:	STAYTON
State	:	OR
Zip	:	97383-2099
Country	:	US
Telephone Number	:	503-769-2641
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2015
Last Update Date	:	04/12/2018

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