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General NPI Number Information
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NPI Number | 1003360058
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Entity Type | Individual
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Provider Name | FITZWILLIAM ESELE MUSOKO APRN
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Gender | Male
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Dates
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Enumeration Date | 08/08/2016
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 1024 W OWENS AVE
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City | LAS VEGAS
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State | NV
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Zip | 89106-2520
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Country | US
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Telephone | 813-420-5470
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Fax |
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Provider Business Mailing Address
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Address Line | 464 BEARDSLEY CIR
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City | HENDERSON
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State | NV
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Zip | 89052-2670
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Country | US
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Telephone | 813-420-5470
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APRN9342679
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN9342679
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 827678
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License Number State | NV
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