Provider Demographics
NPI:1083074306
Name:MUSAKWA, ELLEN (FNP)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:MUSAKWA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37657 BRUTUS WAY
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:CA
Mailing Address - Zip Code:92223-8056
Mailing Address - Country:US
Mailing Address - Phone:951-966-0193
Mailing Address - Fax:
Practice Address - Street 1:108 JEFFERSON CT
Practice Address - Street 2:UNIT A
Practice Address - City:RED BLUFF
Practice Address - State:CA
Practice Address - Zip Code:96080-3865
Practice Address - Country:US
Practice Address - Phone:951-966-0193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-29
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95003212363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily