Provider Demographics
NPI:1972321594
Name:MUSHET, MARILES RALLOS (MSN, AGNP-C)
Entity type:Individual
Prefix:MRS
First Name:MARILES
Middle Name:RALLOS
Last Name:MUSHET
Suffix:
Gender:F
Credentials:MSN, AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 GATEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-9533
Mailing Address - Country:US
Mailing Address - Phone:908-759-9596
Mailing Address - Fax:
Practice Address - Street 1:2007C NEUSE BLVD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28560-3470
Practice Address - Country:US
Practice Address - Phone:252-634-6360
Practice Address - Fax:252-634-6364
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-02
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5020937363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner