Provider Demographics
NPI:1598997090
Name:MUSTAPHA, MUSU (LPN)
Entity Type:Individual
Prefix:
First Name:MUSU
Middle Name:
Last Name:MUSTAPHA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5901 W BROWN DEER RD
Mailing Address - Street 2:UNIT 103
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53223-2364
Mailing Address - Country:US
Mailing Address - Phone:414-355-0585
Mailing Address - Fax:414-365-3454
Practice Address - Street 1:5901 W BROWN DEER RD
Practice Address - Street 2:UNIT 103
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53223-2364
Practice Address - Country:US
Practice Address - Phone:414-355-0585
Practice Address - Fax:414-365-3454
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-17
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI303987164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse