Provider Demographics
NPI:1033669940
Name:MUYCO, VANESSA MAE
Entity Type:Individual
Prefix:
First Name:VANESSA MAE
Middle Name:
Last Name:MUYCO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94-564 KUPUNA LOOP
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-1242
Mailing Address - Country:US
Mailing Address - Phone:808-429-2829
Mailing Address - Fax:
Practice Address - Street 1:94-564 KUPUNA LOOP
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-1242
Practice Address - Country:US
Practice Address - Phone:808-429-2829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-04
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No376G00000XNursing Service Related ProvidersNursing Home Administrator