Provider Demographics
NPI:1700010139
Name:MUSKETT, EUNICE ANNAZBAH (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:EUNICE
Middle Name:ANNAZBAH
Last Name:MUSKETT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:EUNICE
Other - Middle Name:ANN
Other - Last Name:TURNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:520 HIGHWAY 564
Mailing Address - Street 2:GALLUP VA CBOC
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87301
Mailing Address - Country:US
Mailing Address - Phone:505-722-7334
Mailing Address - Fax:505-863-6078
Practice Address - Street 1:520 HIGHWAY 564
Practice Address - Street 2:GALLUP VA CBOC
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301
Practice Address - Country:US
Practice Address - Phone:505-722-7334
Practice Address - Fax:505-863-6078
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-13
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4400207Q00000X
NMPA2005-0010363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical