Provider Demographics
NPI:1598796716
Name:MUSGROVE, JANENE
Entity Type:Individual
Prefix:MRS
First Name:JANENE
Middle Name:
Last Name:MUSGROVE
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 1:1001 COURTNEY DR APT A
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45431-1288
Mailing Address - Country:US
Mailing Address - Phone:608-443-6646
Mailing Address - Fax:937-221-9364
Practice Address - Street 1:1001 COURTNEY DR APT A
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45431-1288
Practice Address - Country:US
Practice Address - Phone:608-443-6646
Practice Address - Fax:937-221-9364
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2630595Medicaid