Healthcare Provider Details

I. General information

NPI: 1881665610
Provider Name (Legal Business Name): LAVERNE ANN MUSCIO RN APN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1945 CORLIES AVE
NEPTUNE NJ
07753-4859
US

IV. Provider business mailing address

19 CORLIES AVE
ALLENHURST NJ
07711-1009
US

V. Phone/Fax

Practice location:
  • Phone: 732-776-4271
  • Fax:
Mailing address:
  • Phone: 732-531-5294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number26NR05541500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: