Individual
MR. MICHAEL V DIMUCCI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN, MSN, FNP-C
Contact information
Practice address
423 FORTRESS BLVD, MORGANTOWN, WV 26508-1351
(612) 805-8676
(249) 201-5231
Mailing address
826 TRENTON LN N, MINNEAPOLIS, MN 55441-4496
(612) 805-8676
(249) 201-5231
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R 112189-4
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
497460300
—
MN
01
—
F0402042
AANP BOARD CERTIFICATION
—
01
—
P0825227
NAT'L REGISTRY PARAMEDIC
—
01
—
R1121894
RN LICENSE
MN
Enumeration date
01/18/2006
Last updated
12/27/2023
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