Healthcare Provider Details

I. General information

NPI: 1851964720
Provider Name (Legal Business Name): JUSTIN MULLER DNP, CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2021
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 ATTUCKS LN UNIT 1B
HYANNIS MA
02601-1813
US

IV. Provider business mailing address

100 HIGH ST
BUFFALO NY
14203-1126
US

V. Phone/Fax

Practice location:
  • Phone: 508-775-7751
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN2350338
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number735945
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1164864
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number176199
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: