Healthcare Provider Details

I. General information

NPI: 1700334760
Provider Name (Legal Business Name): RENEE MUELLER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2016
Last Update Date: 11/08/2021
Certification Date: 11/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6130 OXON HILL RD STE 202
OXON HILL MD
20745-3168
US

IV. Provider business mailing address

6002 W N RIVER DRIVE
SPOKANE WA
99208
US

V. Phone/Fax

Practice location:
  • Phone: 301-567-1767
  • Fax:
Mailing address:
  • Phone: 509-482-4402
  • Fax: 509-482-5071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA60881076
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA031270
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0110-005436
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: