Provider Demographics
NPI:1952071102
Name:MUSSMAN, MARIE ALEXIA (PA-C)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:ALEXIA
Last Name:MUSSMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4221 S SARATOGA ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-5453
Mailing Address - Country:US
Mailing Address - Phone:504-616-3618
Mailing Address - Fax:
Practice Address - Street 1:441 WALL BLVD
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056-7723
Practice Address - Country:US
Practice Address - Phone:504-265-0207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-19
Last Update Date:2021-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA363A00000X
LA328611363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant