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NPI Code Detail

MEDICARE: MARY KATHRYN MUSICK CPNP-AC

MEDICARE: MARY KATHRYN MUSICK CPNP-AC
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
1363L00000XNurse Practitioner4704255022MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14704255022OTHERMINURSE PRACTITIONER LICENSE

General Provider Information

NPI Number : 1336487727
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY KATHRYN MUSICK CPNP-AC
Provider Business Mailing Address
First Line : 26901 BEAUMONT BLVD STE 3D
Second Line :
City : SOUTHFIELD
State : MI
Zip : 48033-3849
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 44201 DEQUINDRE RD STE EC
Second Line :
City : TROY
State : MI
Zip : 48085-1117
Country : US
Telephone Number : 248-964-5111
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/21/2013
Last Update Date : 05/19/2026

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Directions to “ MARY KATHRYN MUSICK CPNP-AC” Practice Location

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