Provider Demographics
NPI:1366863292
Name:MUSUKUMA, TATULINI
Entity Type:Individual
Prefix:
First Name:TATULINI
Middle Name:
Last Name:MUSUKUMA
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 1:544 AZTEC PL
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-2627
Mailing Address - Country:US
Mailing Address - Phone:214-283-7767
Mailing Address - Fax:
Practice Address - Street 1:544 AZTEC PL
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-2627
Practice Address - Country:US
Practice Address - Phone:214-283-7767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-19
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY315041164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse