Healthcare Provider Details

I. General information

NPI: 1174892483
Provider Name (Legal Business Name): TESSA ANN MUSTONEN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2011
Last Update Date: 12/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 S IRONWOOD DR
APACHE JUNCTION AZ
85120-5002
US

IV. Provider business mailing address

4005 W POLLACK ST
PHOENIX AZ
85041-6026
US

V. Phone/Fax

Practice location:
  • Phone: 480-677-7520
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN169848
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: