Provider Demographics
NPI:1346725595
Name:MUSTACHIA, ELISABETH (APRN)
Entity Type:Individual
Prefix:MS
First Name:ELISABETH
Middle Name:
Last Name:MUSTACHIA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1491 S SUNNYLANE RD
Mailing Address - Street 2:
Mailing Address - City:DEL CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73115-3037
Mailing Address - Country:US
Mailing Address - Phone:405-437-2240
Mailing Address - Fax:661-231-3153
Practice Address - Street 1:1491 S SUNNYLANE RD
Practice Address - Street 2:
Practice Address - City:DEL CITY
Practice Address - State:OK
Practice Address - Zip Code:73115-3037
Practice Address - Country:US
Practice Address - Phone:405-437-2240
Practice Address - Fax:661-231-3153
Is Sole Proprietor?:No
Enumeration Date:2018-10-03
Last Update Date:2022-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0079257363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health