Individual
MRS. BETHANY ANNE MUSALLAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP-PC
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
4704244961
MI
363LP0200X
Pediatric Nurse Practitioner
Primary
4704244961
MI
Other
Enumeration date
01/29/2008
Last updated
07/29/2022
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