Healthcare Provider Details

I. General information

NPI: 1821922360
Provider Name (Legal Business Name): JENNIFER MARIE MULLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 E MAIN ST
MIDDLETOWN NY
10940-2650
US

IV. Provider business mailing address

11 DIANE PL
PORT JERVIS NY
12771-1208
US

V. Phone/Fax

Practice location:
  • Phone: 845-333-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number157792
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: