Healthcare Provider Details

I. General information

NPI: 1770909087
Provider Name (Legal Business Name): LISA MUELLER R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2014
Last Update Date: 03/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 KNIGHTSBRIDGE DR
HAMILTON OH
45011-3167
US

IV. Provider business mailing address

250 KNIGHTSBRIDGE DR
HAMILTON OH
45011-3167
US

V. Phone/Fax

Practice location:
  • Phone: 513-868-5650
  • Fax: 513-868-5655
Mailing address:
  • Phone: 513-868-5650
  • Fax: 513-868-5655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1114109
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number344330
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: