MEDICARE: MR. KEVIN B MUESKE 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	163WP0808X	Psychiatric/Mental Health Registered Nurse	6647611-3102	UT

General Provider Information

NPI Number	:	1720273329
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KEVIN B MUESKE RN

Provider Business Mailing Address
First Line	:	13237 S 2480 W
Second Line	:
City	:	RIVERTON
State	:	UT
Zip	:	84065-2265
Country	:	US
Telephone Number	:	801-878-9617
Fax Number	:

Provider Business Practice Location Address
First Line	:	2525 LAKE PARK BLVD
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84120-8230
Country	:	US
Telephone Number	:	801-982-3071
Fax Number	:

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

Provider Enumeration Date	:	09/07/2007
Last Update Date	:	08/09/2011

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