Provider Demographics
NPI:1841346772
Name:MUSSO, VINCENT NICK JR (CRNA)
Entity type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:NICK
Last Name:MUSSO
Suffix:JR
Gender:M
Credentials:CRNA
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:1179 MELODY LN
Mailing Address - Street 2:
Mailing Address - City:HARTWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30643-4257
Mailing Address - Country:US
Mailing Address - Phone:706-376-3373
Mailing Address - Fax:
Practice Address - Street 1:1179 MELODY LN
Practice Address - Street 2:
Practice Address - City:HARTWELL
Practice Address - State:GA
Practice Address - Zip Code:30643-4257
Practice Address - Country:US
Practice Address - Phone:706-376-3373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN147165367500000X
SC3740367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered