Provider Demographics
NPI:1285612200
Name:LAMUSGA, MARY J (PA)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:J
Last Name:LAMUSGA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49725 COUNTY 83
Mailing Address - Street 2:
Mailing Address - City:STAPLES
Mailing Address - State:MN
Mailing Address - Zip Code:56479-5280
Mailing Address - Country:US
Mailing Address - Phone:218-894-1515
Mailing Address - Fax:
Practice Address - Street 1:49725 COUNTY 83
Practice Address - Street 2:
Practice Address - City:STAPLES
Practice Address - State:MN
Practice Address - Zip Code:56479-5280
Practice Address - Country:US
Practice Address - Phone:218-894-1515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9450363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN42B94LAOtherBCBS
IA95124OtherBCBS
970011717OtherRR MEDICARE
MN0110106OtherMEDICA
MNNA2951023879OtherPREFERRED ONE
MN123764OtherUCARE
MN1694595OtherAMERICAS PPO
410849339 56001 C143OtherCHAMPUS
MNHP41031OtherHEALTH PARTNERS
MN507460600Medicaid
MN970000569Medicare ID - Type Unspecified
MN507460600Medicaid