MEDICARE: CHARLESANNA LANGSTON MUSILI

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	164X00000X	Licensed Vocational Nurse	196310	TX

General Provider Information

NPI Number	:	1730721960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLESANNA LANGSTON MUSILI

Provider Business Mailing Address
First Line	:	5825 DIAZ AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-5803
Country	:	US
Telephone Number	:	214-783-8242
Fax Number	:

Provider Business Practice Location Address
First Line	:	5825 DIAZ AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-5803
Country	:	US
Telephone Number	:	214-783-8242
Fax Number	:

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

Provider Enumeration Date	:	10/09/2019
Last Update Date	:	10/09/2019

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