Provider Demographics
NPI:1982058897
Name:MUSSER, LARA
Entity Type:Individual
Prefix:MISS
First Name:LARA
Middle Name:
Last Name:MUSSER
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 1:141 FOREST ST
Mailing Address - Street 2:1
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-3807
Mailing Address - Country:US
Mailing Address - Phone:530-383-2227
Mailing Address - Fax:
Practice Address - Street 1:141 FOREST ST
Practice Address - Street 2:1
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-3807
Practice Address - Country:US
Practice Address - Phone:530-383-2227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-17
Last Update Date:2016-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program