Healthcare Provider Details

I. General information

NPI: 1336120971
Provider Name (Legal Business Name): BECKY JO MUELLER D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 08/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12800 ROLLING RIDGE CENTRACARE CLINIC - BECKER FAMILY MEDICINE
BECKER MN
55308-8838
US

IV. Provider business mailing address

12800 ROLLING RIDGE CENTRACARE CLINIC - BECKER FAMILY MEDICINE
BECKER MN
55308-8838
US

V. Phone/Fax

Practice location:
  • Phone: 763-261-7000
  • Fax: 763-261-7004
Mailing address:
  • Phone: 763-261-7000
  • Fax: 763-261-7004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number46591
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number46591
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: