Basic Information
| Provider Information | |||||||||
| NPI: | 1407043391 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOTTEMOLLER-MUELLER | ||||||||
| FirstName: | JULIE | ||||||||
| MiddleName: | |||||||||
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| Credential: | ACNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3815 E BELL RD STE 2200 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850322139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6026333838 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10815 W MCDOWELL RD STE 202 | ||||||||
| Address2: | |||||||||
| City: | AVONDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853925010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6234330202 | ||||||||
| FaxNumber: | 6234330204 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2007 | ||||||||
| LastUpdateDate: | 10/25/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 209-004398 | IL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LA2100X | 259671 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
ID Information
| ID | Type | State | Issuer | Description | 01621208 | 01 | IL | BLUE CROSS BLUE SHIELD GROUP PROVIDER NUMBER | OTHER | NPI #1508810086 | 01 | IL | HEART CARE CENTERS OF ILLINOIS, S.C. GROUP NPI # | OTHER | P00477809 | 01 | IL | RAILROAD MEDICARE PART B PTAN | OTHER | 041199983 | 05 | IL | MEDICAID | 416810 | 01 | IL | MEDICARE GROUP NUMBER | OTHER | 236550 | 01 | IL | MEDICARE GROUP NUMBER | OTHER | CD8033 | 01 | IL | RAILROAD MEDICARE PART B GROUP NUMBER | OTHER | 236551 | 01 | IL | MEDICARE GROUP NUMBER | OTHER |