Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 827678 | NV |
N | 363L00000X | Nurse Practitioner | APRN9342679 | FL |
N | 363LF0000X | Nurse Practitioner - Family Medicine | APRN9342679 | FL |
NPI | 1003360058 |
---|---|
Provider Name | Fitzwilliam Esele Musoko |
First Address | Henderson, NV 89052-2670 |
Second Address | Las Vegas, NV 89106-2520 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2016 |
Last Update Date | 06/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
018432500 | (05) | FL |
AJW4L | BCBS (01) | FL |
APRN827678 | NV APRN LICENSE (01) | NV |
APRN9342679 | FL LICENSE (01) | |
ME4720199 | DEA (01) |