Provider Demographics
NPI:1013478981
Name:MUSHI, ROSE
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:
Last Name:MUSHI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 COTTAGE ST # 1
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:MA
Mailing Address - Zip Code:02149-4642
Mailing Address - Country:US
Mailing Address - Phone:781-367-0531
Mailing Address - Fax:
Practice Address - Street 1:800 W CUMMINGS PARK STE 4700
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-6554
Practice Address - Country:US
Practice Address - Phone:781-224-0611
Practice Address - Fax:781-224-1993
Is Sole Proprietor?:No
Enumeration Date:2019-03-25
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2274291363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care