Basic Information
| Provider Information | |||||||||
| NPI: | 1497024640 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JULIE MUELLER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1211 | ||||||||
| Address2: | |||||||||
| City: | WILSON | ||||||||
| State: | WY | ||||||||
| PostalCode: | 830141211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6125185527 | ||||||||
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| Practice Location | |||||||||
| Address1: | 436 5TH & TED STEVENS WAY | ||||||||
| Address2: | |||||||||
| City: | KOTZBUE | ||||||||
| State: | AK | ||||||||
| PostalCode: | 997520043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9074423321 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/16/2011 | ||||||||
| LastUpdateDate: | 12/16/2011 | ||||||||
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| AuthorizedOfficialLastName: | MUELLER | ||||||||
| AuthorizedOfficialFirstName: | JULIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6125185527 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PA-C | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 422 | WY | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | 685 | AK | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | MDA0282 | 05 | AK | MEDICAID |