Healthcare Provider Details

I. General information

NPI: 1669741906
Provider Name (Legal Business Name): PAMELA JO MUELLER RN, BSN, FCP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2011
Last Update Date: 12/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 4TH AVE SE
STEWARTVILLE MN
55976-1338
US

IV. Provider business mailing address

3210 105TH ST SE
STEWARTVILLE MN
55976-8043
US

V. Phone/Fax

Practice location:
  • Phone: 507-254-9478
  • Fax:
Mailing address:
  • Phone: 507-254-9478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: