Provider Demographics
NPI:1275131153
Name:MUSSELMAN, JOAN RAEANNA
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:RAEANNA
Last Name:MUSSELMAN
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 1:15 KULANIHAKOI ST APT 12E
Mailing Address - Street 2:
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-7345
Mailing Address - Country:US
Mailing Address - Phone:180-828-2512
Mailing Address - Fax:
Practice Address - Street 1:15 KULANIHAKOI ST APT 12E
Practice Address - Street 2:
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-7345
Practice Address - Country:US
Practice Address - Phone:180-828-2512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator