Provider Demographics
NPI:1174736664
Name:MUSSELMAN, MARGARET ELLYN (APRN-BC)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:ELLYN
Last Name:MUSSELMAN
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 PECAN ST
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:TX
Mailing Address - Zip Code:78602-3819
Mailing Address - Country:US
Mailing Address - Phone:151-236-0848
Mailing Address - Fax:605-462-6631
Practice Address - Street 1:909 PECAN ST
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:TX
Practice Address - Zip Code:78602-3819
Practice Address - Country:US
Practice Address - Phone:512-360-8488
Practice Address - Fax:512-253-2505
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP000895363LP2300X
TXAP143321363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
11945101OtherCAQH