Provider Demographics
NPI:1679834246
Name:MUSSER, ANNA K (RN)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:K
Last Name:MUSSER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5545
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47903-5545
Mailing Address - Country:US
Mailing Address - Phone:765-448-8000
Mailing Address - Fax:
Practice Address - Street 1:550 S HOKE AVE
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IN
Practice Address - Zip Code:46041-2664
Practice Address - Country:US
Practice Address - Phone:765-659-1110
Practice Address - Fax:765-659-2577
Is Sole Proprietor?:No
Enumeration Date:2012-05-31
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28190968A163W00000X
IN71004124A363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201104550Medicaid
IN000000787642OtherANTHEM PROVIDER NUMBER
IN201104550Medicaid