Healthcare Provider Details

I. General information

NPI: 1770565525
Provider Name (Legal Business Name): NANCY C. MULLER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 08/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 1ST CAPITOL DR DEPT. OF PATHOLOGY
SAINT CHARLES MO
63301-2844
US

IV. Provider business mailing address

PO BOX 144333
ORLANDO FL
32814-4333
US

V. Phone/Fax

Practice location:
  • Phone: 636-947-5420
  • Fax: 636-947-5257
Mailing address:
  • Phone: 407-422-9831
  • Fax: 407-648-2065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License Number2002009365
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number2002009365
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: