Healthcare Provider Details

I. General information

NPI: 1073024618
Provider Name (Legal Business Name): CHANTAL FRANCESCA MULLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2017
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 SUNDOWN RD
SUNDOWN NY
12740-4807
US

IV. Provider business mailing address

736 SUNDOWN RD
SUNDOWN NY
12740-4807
US

V. Phone/Fax

Practice location:
  • Phone: 845-636-8253
  • Fax: 845-636-8253
Mailing address:
  • Phone: 845-636-8253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number7204881
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: