Healthcare Provider Details

I. General information

NPI: 1710312087
Provider Name (Legal Business Name): DENISE CASAMENTO MUSSER ACNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2013
Last Update Date: 10/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 HARVARD ST SE
MINNEAPOLIS MN
55455-0362
US

IV. Provider business mailing address

709 WOODHAVEN CT NE
ROCHESTER MN
55906-6936
US

V. Phone/Fax

Practice location:
  • Phone: 507-313-5010
  • Fax:
Mailing address:
  • Phone: 507-313-5010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License NumberR1800775
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: