Provider Demographics
NPI:1861413635
Name:MUELLER-HARMON, JEANNINE M (FNP, PMHPNP)
Entity type:Individual
Prefix:
First Name:JEANNINE
Middle Name:M
Last Name:MUELLER-HARMON
Suffix:
Gender:F
Credentials:FNP, PMHPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 NICOLLET AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-3791
Mailing Address - Country:US
Mailing Address - Phone:612-596-9438
Mailing Address - Fax:612-789-3822
Practice Address - Street 1:1801 NICOLLET AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-3791
Practice Address - Country:US
Practice Address - Phone:612-596-9438
Practice Address - Fax:612-789-3822
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2016-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR0925305363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN654213100Medicaid
MN654213100Medicaid