Provider Demographics
NPI:1114791357
Name:MUCKENFUSS, LADONNA GAYLE
Entity Type:Individual
Prefix:
First Name:LADONNA
Middle Name:GAYLE
Last Name:MUCKENFUSS
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 1:9558 STRAIGHT FRK
Mailing Address - Street 2:
Mailing Address - City:WEST HAMLIN
Mailing Address - State:WV
Mailing Address - Zip Code:25571-7510
Mailing Address - Country:US
Mailing Address - Phone:681-279-7202
Mailing Address - Fax:
Practice Address - Street 1:9558 STRAIGHT FRK
Practice Address - Street 2:
Practice Address - City:WEST HAMLIN
Practice Address - State:WV
Practice Address - Zip Code:25571-7510
Practice Address - Country:US
Practice Address - Phone:681-279-7202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant