Provider Demographics
NPI:1427766617
Name:MUSSINAN, MONICA L
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:L
Last Name:MUSSINAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:L
Other - Last Name:SOUDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1019 LAWRENCE ST
Mailing Address - Street 2:
Mailing Address - City:RIPLEY
Mailing Address - State:OH
Mailing Address - Zip Code:45167-1509
Mailing Address - Country:US
Mailing Address - Phone:937-939-5932
Mailing Address - Fax:
Practice Address - Street 1:1019 LAWRENCE ST
Practice Address - Street 2:
Practice Address - City:RIPLEY
Practice Address - State:OH
Practice Address - Zip Code:45167-1509
Practice Address - Country:US
Practice Address - Phone:937-939-5932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide