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General NPI Number Information
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NPI Number | 1376763599
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Entity Type | Individual
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Provider Name | MRS. MARIA BUENA MUSACCHIO
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Gender | Female
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Dates
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Enumeration Date | 04/30/2007
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Last Update Date | 06/19/2008
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Provider Practice Location Address
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Address Line | 1515 WINDMERE DR
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City | MOUNTAIN HOME
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State | ID
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Zip | 83647-2497
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Country | US
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Telephone | 208-580-1120
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Fax |
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Provider Business Mailing Address
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Address Line | 1515 WINDMERE DR
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City | MOUNTAIN HOME
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State | ID
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Zip | 83647-2497
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Country | US
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Telephone | 208-580-1120
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 996
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number |
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number |
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License Number State | ID
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