Healthcare Provider Details

I. General information

NPI: 1306376108
Provider Name (Legal Business Name): SASHA MUSICK FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SASHA WARD

II. Dates (important events)

Enumeration Date: 06/14/2017
Last Update Date: 07/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 CARROLL ST ROOM 2037
LEBANON VA
24266
US

IV. Provider business mailing address

58 CARROLL ST ROOM 2037
LEBANON VA
24266
US

V. Phone/Fax

Practice location:
  • Phone: 276-883-8062
  • Fax: 276-883-8064
Mailing address:
  • Phone: 276-883-8062
  • Fax: 276-883-8064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024174870
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: