Provider Demographics
NPI:1134903206
Name:MUSANTE, ASHLEY OMEGA
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:OMEGA
Last Name:MUSANTE
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 1:2993 E IVANHOE ST
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-9070
Mailing Address - Country:US
Mailing Address - Phone:561-523-3724
Mailing Address - Fax:
Practice Address - Street 1:2993 E IVANHOE ST
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-9070
Practice Address - Country:US
Practice Address - Phone:561-523-3724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9344875163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse