Provider Demographics
NPI:1780878637
Name:MUEHLIG, JENNIFER ANN (LPN)
Entity type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:ANN
Last Name:MUEHLIG
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8486 W BERGEN RD
Mailing Address - Street 2:LOT 8
Mailing Address - City:LE ROY
Mailing Address - State:NY
Mailing Address - Zip Code:14482-9337
Mailing Address - Country:US
Mailing Address - Phone:585-781-0006
Mailing Address - Fax:
Practice Address - Street 1:8486 W BERGEN RD
Practice Address - Street 2:LOT 8
Practice Address - City:LE ROY
Practice Address - State:NY
Practice Address - Zip Code:14482-9337
Practice Address - Country:US
Practice Address - Phone:585-781-0006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-04
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00150120164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02551646Medicaid