Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | COA.05183-NP | OH |
NPI | 1003816869 |
---|---|
Provider Name | Elizabeth Musolf |
First Address | Sandusky, OH 44871-0378 |
Second Address | Genoa, OH 43430-1143 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2005 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2196243 | (05) | OH |
4664546 | (05) | MI |