MEDICARE: LAUREN MICHELLE MULLER PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	0110008002	VA

General Provider Information

NPI Number	:	1518635143
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN MICHELLE MULLER PA-C

Provider Business Mailing Address
First Line	:	20582 SARATOGA CT
Second Line	:
City	:	ASHBURN
State	:	VA
Zip	:	20147-3621
Country	:	US
Telephone Number	:	571-234-2353
Fax Number	:

Provider Business Practice Location Address
First Line	:	4158 DALE BLVD
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22193-2225
Country	:	US
Telephone Number	:	703-680-5959
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2021
Last Update Date	:	08/30/2021

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