Provider Demographics
NPI:1316350010
Name:MUSCO, NATALIE (RPA-C)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:MUSCO
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:
Other - Last Name:MCKENZIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NATALIE O'BRIEN
Mailing Address - Street 1:20 YORK STREET
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511
Mailing Address - Country:US
Mailing Address - Phone:203-688-1418
Mailing Address - Fax:203-688-1460
Practice Address - Street 1:20 YORK ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3220
Practice Address - Country:US
Practice Address - Phone:203-688-1418
Practice Address - Fax:203-688-1460
Is Sole Proprietor?:No
Enumeration Date:2014-06-10
Last Update Date:2018-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017559363A00000X
CT3102363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT3102OtherCT PA LICENSE