Healthcare Provider Details

I. General information

NPI: 1700010139
Provider Name (Legal Business Name): EUNICE ANNAZBAH MUSKETT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: EUNICE ANN TURNER

II. Dates (important events)

Enumeration Date: 05/13/2009
Last Update Date: 08/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 HIGHWAY 564 GALLUP VA CBOC
GALLUP NM
87301
US

IV. Provider business mailing address

520 HIGHWAY 564 GALLUP VA CBOC
GALLUP NM
87301
US

V. Phone/Fax

Practice location:
  • Phone: 505-722-7334
  • Fax: 505-863-6078
Mailing address:
  • Phone: 505-722-7334
  • Fax: 505-863-6078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4400
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2005-0010
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA2005-0010
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: