Provider Demographics
NPI:1205531142
Name:MUSE, CHARLOTTE A
Entity type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:A
Last Name:MUSE
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 1:727 W WORTHY ST
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-3844
Mailing Address - Country:US
Mailing Address - Phone:225-348-0700
Mailing Address - Fax:
Practice Address - Street 1:727 W WORTHY ST
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-3844
Practice Address - Country:US
Practice Address - Phone:225-348-0700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-31
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA005650949172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver