Healthcare Provider Details

I. General information

NPI: 1497188668
Provider Name (Legal Business Name): BROOKE MUZIO CUDNEY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BROOKE ROCHELLE MUZIO

II. Dates (important events)

Enumeration Date: 08/12/2013
Last Update Date: 03/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2006 HOLTON RD
MUSKEGON MI
49445-1505
US

IV. Provider business mailing address

PO BOX 1848
MUSKEGON MI
49443-1848
US

V. Phone/Fax

Practice location:
  • Phone: 231-672-3333
  • Fax: 231-672-3465
Mailing address:
  • Phone: 866-611-1512
  • Fax: 231-728-4789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704276078
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: