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General NPI Number Information
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NPI Number | 1508346750
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Entity Type | Organization
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Legal Business Name | PRECISION HEALTH FAMILY FUNCTIONAL MEDICINE, PA, LLC
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Dates
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Enumeration Date | 08/17/2018
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Last Update Date | 08/17/2018
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Provider Practice Location Address
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Address Line | 10 PLAZA DR STE 203
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City | SCARBOROUGH
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State | ME
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Zip | 04074-1801
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Country | US
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Telephone | 207-219-8445
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Fax | 888-965-0540
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Provider Business Mailing Address
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Address Line | 10 PLAZA DR STE 203
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City | SCARBOROUGH
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State | ME
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Zip | 04074-1801
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Country | US
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Telephone | 207-219-8445
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Fax | 888-965-0540
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Authorized Official
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Title or Position | OWNER, MEDICAL DIRECTOR
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Name | ANNETTE BONNIE MUELLER
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Credential | FNP-BC
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Telephone | 207-219-8446
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | CNP101009
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License Number State | ME
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