Provider Demographics
NPI:1639636913
Name:MUSKETT, SALLY ANN (DNP, NNP-NC)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:ANN
Last Name:MUSKETT
Suffix:
Gender:F
Credentials:DNP, NNP-NC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2470 DEXTER AVE N APT 301
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-2248
Mailing Address - Country:US
Mailing Address - Phone:206-681-6881
Mailing Address - Fax:
Practice Address - Street 1:3333 BURNET AVE, ML 1013
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-3026
Practice Address - Country:US
Practice Address - Phone:513-636-4466
Practice Address - Fax:513-636-5846
Is Sole Proprietor?:No
Enumeration Date:2019-02-22
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.025110363LN0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal