Healthcare Provider Details

I. General information

NPI: 1508945866
Provider Name (Legal Business Name): ROCHELLE D MUSE PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 03/21/2024
Certification Date: 03/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

371 NC HWY 65 SUITE 204
WENTWORTH NC
27375
US

IV. Provider business mailing address

371 NC HWY 65 SUITE 204
WENTWORTH NC
27375
US

V. Phone/Fax

Practice location:
  • Phone: 336-342-8140
  • Fax: 336-342-8128
Mailing address:
  • Phone: 336-342-8140
  • Fax: 336-342-8128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number001000657
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number001000657
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: