Individual provider Active NPI

Deanne Evelyn Mueller, FAMILY NURSE PRACTIT

  • Family Nurse Practitioner
  • West Bend, WI
National Provider Identifier
1467975383
Registry record updated Jul 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
7792-33 Issued in WI
Practice address
1070 Poplar St
West Bend, WI 53095-3139
Phone
(262) 353-0545
NPI assigned
Jul 23, 2017
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 6, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 7792-33 WI Primary

Addresses

Primary practice location

1070 Poplar St
West Bend, WI 53095-3139

Mailing address

W278N2409 Prospect Ave
Pewaukee, WI 53072-5219

Other names 1

  • Deanne Evelyn Dunder Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180409000140 WI Practitioner - Nurse Practitioner 8325301195 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
7792-33WIMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Vpa PC CurrentSince Apr 5, 2019 Accepting new patients
Vpa PC Current Accepting new patients
Vpa PC CurrentSince Apr 5, 2019 Accepting new patients
Chestnut Medicine of Wi LTD CurrentSince Jun 1, 2023 Accepting new patients
Lakeshore Medical Clinic, LLC Past Accepting new patients
Integrative Medical and Wellness, LLC Past Accepting new patients

Locations

13555 Bishops Ct
Ste 315
Brookfield, WI 53005
Phone (414) 255-0300

1451 Cleveland Ave
Waukesha, WI 53186
Phone (262) 547-2123

5301 W Lincoln Ave
West Allis, WI 53219
Phone (414) 615-7200

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1500768000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688601600000",
    "number": "1467975383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "W278N2409 PROSPECT AVE",
            "city": "PEWAUKEE",
            "state": "WI",
            "postal_code": "530725219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1070 POPLAR ST",
            "city": "WEST BEND",
            "state": "WI",
            "postal_code": "530953139",
            "telephone_number": "262-353-0545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUELLER",
        "first_name": "DEANNE",
        "middle_name": "EVELYN",
        "credential": "FAMILY NURSE PRACTIT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-07-23",
        "last_updated": "2023-07-06",
        "certification_date": "2023-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WI",
            "license": "7792-33",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DEANNE",
            "last_name": "DUNDER",
            "middle_name": "EVELYN",
            "credential": "NURSE PRACTITIONER",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in West Bend, WI

Sources for this page

Verify at the official NPI Registry.