Healthcare Provider Details

I. General information

NPI: 1760875793
Provider Name (Legal Business Name): MARCIA RAE MUELLER APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2015
Last Update Date: 03/22/2023
Certification Date: 03/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9200 W WISCONSIN AVE
MILWAUKEE WI
53226-3522
US

IV. Provider business mailing address

9200 W WISCONSIN AVE
MILWAUKEE WI
53226-3522
US

V. Phone/Fax

Practice location:
  • Phone: 414-955-0350
  • Fax: 414-805-6851
Mailing address:
  • Phone: 414-955-0350
  • Fax: 414-805-6851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number6283-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: