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General NPI Number Information
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NPI Number | 1528625969
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Entity Type | Individual
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Provider Name | NICOLE JOAN MUSKETT PA
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Gender | Female
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Dates
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Enumeration Date | 05/21/2019
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Last Update Date | 09/11/2024
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Provider Practice Location Address
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Address Line | 2875 TINA AVE STE 101
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City | MISSOULA
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State | MT
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Zip | 59808-1582
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Country | US
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Telephone | 406-728-3366
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Fax | 406-728-0651
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Provider Business Mailing Address
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Address Line | 2875 TINA AVE STE 101
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City | MISSOULA
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State | MT
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Zip | 59808-1582
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Country | US
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Telephone | 406-728-3366
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Fax | 406-728-0651
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | MED-PCA-LIC-79321
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License Number State | MT
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