Provider Demographics
NPI:1689431884
Name:MUSSO, LEANN NICOLE (PAC)
Entity Type:Individual
Prefix:MRS
First Name:LEANN
Middle Name:NICOLE
Last Name:MUSSO
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:MISS
Other - First Name:LEANN
Other - Middle Name:NICOLE
Other - Last Name:SPINGLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:118 VERMONT ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14609-4907
Mailing Address - Country:US
Mailing Address - Phone:315-283-6278
Mailing Address - Fax:
Practice Address - Street 1:601 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-0002
Practice Address - Country:US
Practice Address - Phone:585-275-2100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031366363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant