Provider Demographics
NPI:1346583564
Name:MUSE, LADONNA KAY
Entity Type:Individual
Prefix:
First Name:LADONNA
Middle Name:KAY
Last Name:MUSE
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 1:1310 SW JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73501-7216
Mailing Address - Country:US
Mailing Address - Phone:580-355-6353
Mailing Address - Fax:
Practice Address - Street 1:1310 SW JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-7216
Practice Address - Country:US
Practice Address - Phone:580-355-6353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-05
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor