Healthcare Provider Details

I. General information

NPI: 1922504281
Provider Name (Legal Business Name): MARLENA ROSE MUELLER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2018
Last Update Date: 05/29/2024
Certification Date: 05/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14101 FAIRVIEW DR
BURNSVILLE MN
55337-4590
US

IV. Provider business mailing address

319 15TH AVE SE
MINNEAPOLIS MN
55455-0118
US

V. Phone/Fax

Practice location:
  • Phone: 855-324-7843
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number34.015669
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number74538
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number74538
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: