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General NPI Number Information
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NPI Number | 1336120971
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Entity Type | Individual
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Provider Name | BECKY JO MUELLER D.O.
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Gender | Female
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Dates
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Enumeration Date | 11/10/2005
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Last Update Date | 08/16/2013
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Provider Practice Location Address
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Address Line | 12800 ROLLING RIDGE CENTRACARE CLINIC - BECKER FAMILY MEDICINE
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City | BECKER
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State | MN
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Zip | 55308-8838
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Country | US
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Telephone | 763-261-7000
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Fax | 763-261-7004
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Provider Business Mailing Address
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Address Line | 12800 ROLLING RIDGE CENTRACARE CLINIC - BECKER FAMILY MEDICINE
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City | BECKER
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State | MN
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Zip | 55308-8838
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Country | US
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Telephone | 763-261-7000
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Fax | 763-261-7004
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 46591
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | 46591
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License Number State | MN
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