Healthcare Provider Details

I. General information

NPI: 1043931140
Provider Name (Legal Business Name): MRS. DIANE STEPHANIE MUSSELWHITE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2022
Last Update Date: 09/07/2022
Certification Date: 09/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2090 RIVER REACH DR APT 43
NAPLES FL
34104-5276
US

IV. Provider business mailing address

2090 RIVER REACH DR APT 43
NAPLES FL
34104-5276
US

V. Phone/Fax

Practice location:
  • Phone: 954-702-3097
  • Fax:
Mailing address:
  • Phone: 954-702-3097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License NumberRN9435041
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: