MEDICARE: MS. SUE HELEN MUSTALISH RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	219852L	PA

General Provider Information

NPI Number	:	1306451745
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUE HELEN MUSTALISH RN

Provider Business Mailing Address
First Line	:	255 FAIRVIEW RD
Second Line	:
City	:	EAST FALLOWFIELD TOWNSHIP
State	:	PA
Zip	:	19320-4448
Country	:	US
Telephone Number	:	610-405-0709
Fax Number	:

Provider Business Practice Location Address
First Line	:	706 E MARKET ST STE 7B
Second Line	:
City	:	WEST CHESTER
State	:	PA
Zip	:	19382-4839
Country	:	US
Telephone Number	:	610-405-0709
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2020
Last Update Date	:	09/12/2020

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