Provider Demographics
NPI:1306261508
Name:MUSCATELL, GENEVIEVE (PA-C)
Entity type:Individual
Prefix:
First Name:GENEVIEVE
Middle Name:
Last Name:MUSCATELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:GENEVIEVE
Other - Middle Name:
Other - Last Name:DAUGHERTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:630 W STATE HIGHWAY 46
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:IN
Mailing Address - Zip Code:47460-6439
Mailing Address - Country:US
Mailing Address - Phone:888-862-9525
Mailing Address - Fax:833-638-0139
Practice Address - Street 1:630 W STATE HIGHWAY 46
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:IN
Practice Address - Zip Code:47460-6439
Practice Address - Country:US
Practice Address - Phone:888-862-9525
Practice Address - Fax:833-638-0139
Is Sole Proprietor?:No
Enumeration Date:2014-02-25
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10001526A172V00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No172V00000XOther Service ProvidersCommunity Health Worker