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Individual
TERESA MUSTELIER
Active
Individual
TERESA MUSTELIER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
002319
GA
363AM0700X
Medical Physician Assistant
002319
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100001328
—
GA
05
—
100001328A
—
GA
05
—
100001328B
—
GA
01
—
10043470
AMERIGROUP
GA
01
—
204856
BCBS
GA
01
—
333580
WELLCARE
GA
Enumeration date
05/17/2006
Last updated
12/19/2008
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