Healthcare Provider Details

I. General information

NPI: 1780087247
Provider Name (Legal Business Name): NINA MUSAELIAN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2014
Last Update Date: 06/13/2023
Certification Date: 06/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 SEYMOUR ST
HARTFORD CT
06106-3315
US

IV. Provider business mailing address

2527 WINDGATE LN
FRISCO TX
75033-7695
US

V. Phone/Fax

Practice location:
  • Phone: 860-972-2117
  • Fax: 860-545-1784
Mailing address:
  • Phone: 860-877-6727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP142448
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number6024
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: