MEDICARE: DEANNA LYNN MUTH

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	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1427838341
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEANNA LYNN MUTH

Provider Business Mailing Address
First Line	:	718 SAINT LOUIS PL
Second Line	:
City	:	BISMARCK
State	:	ND
Zip	:	58504-7106
Country	:	US
Telephone Number	:	701-202-1526
Fax Number	:

Provider Business Practice Location Address
First Line	:	718 SAINT LOUIS PL
Second Line	:
City	:	BISMARCK
State	:	ND
Zip	:	58504-7106
Country	:	US
Telephone Number	:	701-202-1526
Fax Number	:

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

Provider Enumeration Date	:	09/29/2023
Last Update Date	:	09/29/2023

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Directions to “ DEANNA LYNN MUTH ” Practice Location

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