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General NPI Number Information
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NPI Number | 1295912624
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Entity Type | Individual
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Provider Name | BETHANY ANNE MUSALLAM CPNP-PC
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Gender | Female
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Dates
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Enumeration Date | 01/29/2008
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Last Update Date | 07/29/2022
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Provider Practice Location Address
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Address Line | 15125 22 MILE RD. SHELBY PEDIATRICS
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City | SHELBY TOWNSHIP
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State | MI
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Zip | 48315
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Country | US
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Telephone | 586-532-0599
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Fax | 586-566-8967
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Provider Business Mailing Address
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Address Line | 15125 22 MILE RD. SHELBY PEDIATRICS
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City | SHELBY TWP
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State | MI
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Zip | 48315
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Country | US
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Telephone | 586-532-0599
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Fax | 586-566-8967
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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 | 4704244961
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 4704244961
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License Number State | MI
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