Provider Demographics
NPI:1093563439
Name:MUSSANO, MINDY (RN)
Entity type:Individual
Prefix:
First Name:MINDY
Middle Name:
Last Name:MUSSANO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1837 WILSIE RD
Mailing Address - Street 2:
Mailing Address - City:FRAMETOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26623-7187
Mailing Address - Country:US
Mailing Address - Phone:304-644-9431
Mailing Address - Fax:
Practice Address - Street 1:66 HOSPITAL PLZ STE 103
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:WV
Practice Address - Zip Code:26452-8595
Practice Address - Country:US
Practice Address - Phone:304-269-3108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV91185163WP1700X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WP1700XNursing Service ProvidersRegistered NursePerinatal