Provider Demographics
NPI:1528876752
Name:MUSTA, LEONIDA NIKITA (RN, BSN, PHN)
Entity type:Individual
Prefix:
First Name:LEONIDA
Middle Name:NIKITA
Last Name:MUSTA
Suffix:
Gender:F
Credentials:RN, BSN, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15875 EMPEROR AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-7803
Mailing Address - Country:US
Mailing Address - Phone:612-749-1703
Mailing Address - Fax:
Practice Address - Street 1:15875 EMPEROR AVE STE 120
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-7803
Practice Address - Country:US
Practice Address - Phone:612-749-1703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-19
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2513281163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse