Provider Demographics
NPI:1063409159
Name:MUSSELMAN, VICKI H (NP)
Entity type:Individual
Prefix:
First Name:VICKI
Middle Name:H
Last Name:MUSSELMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 E ARCH ST
Mailing Address - Street 2:
Mailing Address - City:IRONWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49938-2047
Mailing Address - Country:US
Mailing Address - Phone:906-932-5506
Mailing Address - Fax:
Practice Address - Street 1:719 N 3RD AVE
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-2965
Practice Address - Country:US
Practice Address - Phone:715-675-9858
Practice Address - Fax:715-675-5475
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner