Provider Demographics
NPI:1710971510
Name:MUSTO, ROXANNE F (NP)
Entity Type:Individual
Prefix:
First Name:ROXANNE
Middle Name:F
Last Name:MUSTO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 HIGHLAND ST
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186-3800
Mailing Address - Country:US
Mailing Address - Phone:617-696-4600
Mailing Address - Fax:617-696-7699
Practice Address - Street 1:92 HIGHLAND ST
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:MA
Practice Address - Zip Code:02186-3800
Practice Address - Country:US
Practice Address - Phone:617-696-4600
Practice Address - Fax:617-696-7699
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA187372363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0391140Medicaid
MA0391140Medicaid
MANP3736Medicare ID - Type Unspecified