Provider Demographics
NPI:1285656306
Name:MUSIELAK, MARTHA LOU (APRN-BC)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:LOU
Last Name:MUSIELAK
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:MS
Other - First Name:MARTHA
Other - Middle Name:LOU
Other - Last Name:MUSIELAK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN-BC
Mailing Address - Street 1:901 WOODCREST DR
Mailing Address - Street 2:
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-3575
Mailing Address - Country:US
Mailing Address - Phone:281-482-8414
Mailing Address - Fax:
Practice Address - Street 1:2002 HOLCOMBE BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4211
Practice Address - Country:US
Practice Address - Phone:713-794-7173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX44885363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXGNP004386Medicaid
TXGNP004386Medicaid