Provider Demographics
NPI:1306451745
Name:MUSTALISH, SUE HELEN (RN)
Entity type:Individual
Prefix:MS
First Name:SUE
Middle Name:HELEN
Last Name:MUSTALISH
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 1:255 FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:EAST FALLOWFIELD TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:19320-4448
Mailing Address - Country:US
Mailing Address - Phone:610-405-0709
Mailing Address - Fax:
Practice Address - Street 1:706 E MARKET ST STE 7B
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19382-4839
Practice Address - Country:US
Practice Address - Phone:610-405-0709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-12
Last Update Date:2020-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA219852L163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse