=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700559085
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JANET MARY MUELLER APN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/01/2021
-----------------------------------------------------
Last Update Date | 08/01/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2718 N PROSPECT AVE
-----------------------------------------------------
City | CHAMPAIGN
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61822-1298
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 217-337-3852
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2708 STRATMOOR DR
-----------------------------------------------------
City | BLOOMINGTON
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61705-4120
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 309-319-4168
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 209023575
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------