Provider Demographics
NPI:1003816869
Name:MUSOLF, ELIZABETH (CPNP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:MUSOLF
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 378
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44871-0378
Mailing Address - Country:US
Mailing Address - Phone:419-609-1112
Mailing Address - Fax:419-609-1123
Practice Address - Street 1:22614 W STATE ROUTE 51
Practice Address - Street 2:
Practice Address - City:GENOA
Practice Address - State:OH
Practice Address - Zip Code:43430-1143
Practice Address - Country:US
Practice Address - Phone:419-855-7772
Practice Address - Fax:419-855-4800
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-22
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH05183164W00000X
OHCOA.05183-NP363LP0200X
OHCOA-05183-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No164W00000XNursing Service ProvidersLicensed Practical Nurse
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2196243Medicaid
MI4664546Medicaid