Provider Demographics
NPI:1750898953
Name:MUSOKE, DENISE RENEE (LPN)
Entity type:Individual
Prefix:MS
First Name:DENISE
Middle Name:RENEE
Last Name:MUSOKE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11802 FARRINGDON AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44105-2508
Mailing Address - Country:US
Mailing Address - Phone:216-854-2640
Mailing Address - Fax:
Practice Address - Street 1:1710 PROSPECT AVE E FL 6
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115-2322
Practice Address - Country:US
Practice Address - Phone:216-781-3773
Practice Address - Fax:217-781-2023
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-09
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN110227MEDS164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse