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NPI Code Detail

MEDICARE: MR. MICHAEL V DIMUCCI RN, MSN, FNP-C

MEDICARE: MR. MICHAEL V DIMUCCI RN, MSN, FNP-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerR 112189-4MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2F0402042OTHERAANP BOARD CERTIFICATION
3P0825227OTHERNAT'L REGISTRY PARAMEDIC
4R1121894OTHERMNRN LICENSE
5MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1083694806
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MICHAEL V DIMUCCI RN, MSN, FNP-C
Provider Business Mailing Address
First Line : 826 TRENTON LN N
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55441-4496
Country : US
Telephone Number : 612-805-8676
Fax Number : 249-201-5231
Provider Business Practice Location Address
First Line : 423 FORTRESS BLVD
Second Line :
City : MORGANTOWN
State : WV
Zip : 26508-1351
Country : US
Telephone Number : 612-805-8676
Fax Number : 249-201-5231
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/18/2006
Last Update Date : 12/27/2023

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