Healthcare Provider Details

I. General information

NPI: 1255310231
Provider Name (Legal Business Name): FREDA MUSIAL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 06/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 PARK ST EMERGENCY DEPT
HONESDALE PA
18431-1445
US

IV. Provider business mailing address

38935 ANN ARBOR RD SUITE 201
LIVONIA MI
48150-3354
US

V. Phone/Fax

Practice location:
  • Phone: 570-253-8140
  • Fax: 866-250-6385
Mailing address:
  • Phone: 734-632-0175
  • Fax: 734-632-0182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704150548
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024167850
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP009678
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: